Symbicort?

Hi everyone.

I had totally forgotten about this site until yesterday when I took my 6 yr old for his usual hospital check up. After going quite literally purple in the face (me) tyring to explain to this registar how bad my sons asthma actually is and her mis typed letter to our GP resulted in him being refused his medication a few weeks ago. She finally agreed (reluctantly) that it probably isn't under control after all. Sorry but you have no idea what I have been through with his medication recently. Anyway to cut a long story short she has given him Symbicort its a powder inhaler and replaces his brown one. Thing is she never really said much about it. She has also given us a peak flow wotsit but no indication as to what he should be at. I have made an appointment with our GP for next week but was wondering in the meantime does anyone know much about this stuff?

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Hi Giz,

Symbicort is a mixture of two drugs mixed together. The first being Budesonide and the second being Formoterol. A mixture of a long acting bronchodilator and a preventer. The inhalers usually come in 200/6 and 400/12 dosages.

At the age of 6 I am assuming that your son has the 200/6 dose inhaler. My concern with this being prescribed is that he may not have enough inspiratory flow at the age of 6 to use this inhaler properly. A patient needs a minimum inpiratory flow rate of between 60-90 litres per minute to use a turbohaler. I have had patients much older than your son who are unable to use this device properly. The problem is drug deposition, if not inhaled correctly the drug particles won't get deposited in the right places and so the inhaler will be less efficient.

I am also concerned that you have had a battle to get this precribed. My advice to you would be an urgent refferal to your asthma nurse at the surgery to discuss this and get your sons inspiratory flow rate checked.

Assuming your son sufficient inspiratory flow rate for the turbohaler, the correct way to use can be found on the internet by doing a simple google search. If all else fails please message me and I can instruct further.

Try not to worry, at least you have done the right thing by being persistant. The medications just needs checking for compatibility with your son now. I am dissapointed though that you have had to battle for some kind of intervention.

Best wishes.

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Wot Gavin said, plus:

Symbicort also comes as 100/6 doseage. A good inhaler demo can be found on this site - asthma.org.uk/using_your.html - click on the picture of the turbohaler.

Regarding peak flows, each person has their own individual ""best"" and it is more the pattern over time that is important. However, you can find a chart of averages at peakflow.com/top_nav/normal...

Good luck, hope this helps!

CathBear.

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Thank you both for your advice, much appreciated. My son is taking the 100/6 dose 2 puffs twice a day. When we were at the hospital one of the nurses tried him on a dummy one which was attached to a pyramid machine with 3 lights he was consistantly bringing up 2 of these. She was also slightly concerned that he may not be able to use it effectivly and suggested that we keep an eye on him and if it appeared to not be working to go back on the brown inhaler until we saw the GP on Tuesday.

I saw on the example video that it says you may not be able to taste the powder. Does this mean that if you do taste it then it hasn't gone in properlly?

The peak flow I have started recording twice a day before his inhaler so I can show the GP, then I am assuming he will beable to give us a better idea of what his stats are.

I too am concerned at the amount of trouble I have had. He was diagnosed aged 1 and is now 6. The GPs and nurses have been great but as soon as things started going wrong and he ended up having to go to the hospital it has been a nightmare. Last school year he missed a huge amount of time due to his asthma. He was admitted to hospital on 2 occasions because the school were not giving him his blue inhaler when he needed it. Thankfully he starts a new school after half term and they seem well informed and understanding.

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Thanks Cathbear, I knew when reading it back I had missed something! The 100/6 dose!

Giz, can you advise on your sons peak flow readings? You are doing the right thing testing it twice daily and it sounds like your son may be borderline for being able to use the symbicort. Children do vary and some are able to use it but with the nurse being concerned that he didn't light up all three lights it makes me think that on a 'bad' day he wont be getting the medication on board. Not having used the 100/6 dose myself I cant say if he should be able to taste it, I can taste the 200/6 daily but remember if he is unwell etc that may 'mask' the taste.

To be honest it will be 'trial and error' with the symbicort or any other medication for your son. The best way of progression is to continue with the symbicort, reminding your son to breath in as hard as he can, hold his breath and continue with the peak flow readings. You should notice that his readings should either improve and/or stay continuous without dropping unless particularly unwell.

Keep us informed. Well done for being a very pro-active mum with your sons asthma.

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I have only done the peak flow a couple of times and it was around the 150 mark. The reason I asked about taste is because it can be tricky to know if something like this is going in been as you can't see it. I used to have very mild asthma as a child and remember the taste of the blue inhaler so I always asked him when he had his inhalers if he could taste it, this also helped with knowing when it was running low.

I'm amazed that no all parents take their childrens asthma more seriously to be honest. It is after all life threatening. I was also horrified at the registars comment on because he had never been in ICU his asthma wasn't 'that bad' and it didn't warrent messing about with his medication. Glad she changed her mind. I have also found that the hospital seem insistant on trying to put him back on montelucast dispite knowing he is alleric to it. One person my husband saw with him was quite determind to give it to him again until my husband said that we would refuse to give him the tablets knowing what they did to him. Pity really because they seem to work a treat.

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Hi I am new to this site but not new to asthma. My daughter (age 8) was diagnosed with asthma at a very young age (she also has lots of allergies, ezcema, hayfever etc.) She was given symbicort when she was 6 to replace her brown inhaler as she was going through a very bad patch with her asthma. She also has montelukast tablets. She uses the inhaler morning and night and I must say it has worked wonders. Since she has been on it her asthma has been very well controlled. We just make sure she gives a good breath in and you must make sure that they then go and swill there mouth out with water as it can cause oral thrush . We make sure our daughter does this and she has never had any problems.

She also was given a peak flow at about the same time and we were told that what they should be getting on it was down to height and weight of the child so it was very individual. Also that over a period of time you should see a pattern and the average of what they are getting. My daughters used to be areound 150 it is now an average of 200 and if it starts to drop by a significant about then it could be a sign of her asthma getting worse.

I hope everything works out well for your son. You just have to make sure that you are happy with the medication he has and that you can see an improvement.