Symbicort SMART, histamine challenge test, ethanol free atrovent

Hi everyone,

Several questions here. Just wondered if anyone has any positive or negative views to share about Symbicort SMART.

I've just been switched from Seretide to Symbicort. I understand the principle, however I'm slightly paranoid about bone density at the moment (with good reason), and I'm not sure I really want any more steroids in my system. I do understand, however, that if SMART cuts down on prednisolone courses then that'd be useful, and probably good for my bones. I also understand that inhaled does are very low, but I've had some very broken bones this year, and am now concerned (I'm waiting for a dexa scan). Maybe my bone issues are a coincidence, and I'm sure it's quite rare if it's not a coincidence - I certainly don't want to start a inhaled-steroid-fear.

I was told that I should take Ventolin alongside Symbicort, considering how much reliever I use. Am I right in assuming that I might as well use Ventolin over Symbicort if it's for exercise, or because I'm in contact with a (temporary) trigger? Because these are bound to cause asthma issues, and are different to 'underlying inflammation' - right?

SMART sounds like a great idea in some respects though - I am terrible at admitting I need Pred, and often regret not taking it, or not taking it sooner, so this may work well for me. I was also told that doubling Seretide (which I used to do a lot, not knowing I wasn't meant to!) means the salmeterol can make you very shaky. I'm totally up for being less shaky, if Symbicort achieves this.

I was prescribed Symbicort SMART 400/12 by a consultant yesterday - I was feeling this was a pretty high dose to be taking two times twice a day, and up to 12 if needed - and searching old posts says my guess on that would be correct. I used to be on Seretide 250, two puffs twice a day - so I would have thought Symbicort 200 would be OK? No doctors were available over the phone today, but I'll try and speak to someone on Monday. Does anyone know if the doses of the steroid component of both have equivalent effects (isn't there one steroid which you only need to take half of to get the same effect as others?)

Question 2: I'm waiting for a histamine challenge test. The cons said this was to check I did have asthma (fair enough, as my peak flows often don't mirror how I feel). However, skin prick tests are negative on me. (I've never noticed being worse around typical triggers, except some pollens - and these were still negative on skin test). I didn't have a particularly big skin reaction to histamine. So, I guess I have non-allergic asthma. So, if a histamine challenge test for asthma is negative, does that totally rule out asthma, or just mean its not allergy based? (I am very 'asthma-allergic' - I think - to wine, although a sulphite challenge test was negative.)

Question 3: Does anyone know if it's possible to get atrovent inhalers which do not contain an ethanol propellant? (I think the wine allergy has roots in an ethanol allergy, as I've been very ill after using Salamol. I respond well to atrovent nebs.)

Phew. Question overload. Sorry! Cheers.

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Hi C,Sorry to here you've been having trouble with broken bones as well as asthma - I hope your dexa scan goes well. I don't have answers for all of your questions but thought I would offer some thoughts about symbicort and hope other friendly (and much more knowledgeable) people come along soon. I am on the 400/12 inhaler 2 doses morning and evening too. But I thought the SMART system was used with the lower doses of symbicort not the 400 one?? Could be completely wrong about that but I think your plan of phoning a Dr is a good one, the AUK asthma nurses are really helpfull as well so could be useful to call them. As for the shakes, I don't find symbicort too bad, it's just increased use of my reliever that does that, and makes keeping a cup of coffee stable a bit challenging!! Fingers crossed symbicort works for you and you get more information soon.Take careLee

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Hi C,Sorry to here you've been having trouble with broken bones as well as asthma - I hope your dexa scan goes well. I don't have answers for all of your questions but thought I would offer some thoughts about symbicort and hope other friendly (and much more knowledgeable) people come along soon. I am on the 400/12 inhaler 2 doses morning and evening too. But I thought the SMART system was used with the lower doses of symbicort not the 400 one?? Could be completely wrong about that but I think your plan of phoning a Dr is a good one, the AUK asthma nurses are really helpfull as well so could be useful to call them. As for the shakes, I don't find symbicort too bad, it's just increased use of my reliever that does that, and makes keeping a cup of coffee stable a bit challenging!! Fingers crossed symbicort works for you and you get more information soon.Take careLee

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Thanks for your reply, Lee.

Yep, other older messages on this forum say that 400/12 isn't meant to be part of the SMART system, the 200 and 100 ones are.

The nurse said that taking too much (i.e. 8 puffs of 250) Seretide can make you shaky, unlike Symbicort. I seem to (relatively randomly) get shaky with Ventolin every so often, sometimes on low doses, which can make some of the more fiddly bits of my work a bit rubbish!

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Hi C - just briefly - the steroid in Symbicort is budesonide, and only has half the ""potency"" of fluticasone (the steroid in Seretide). Also Lee is right, the 200/6 and 100/6 are the only one licensed for use on the SMART system, however docs often prescribe outside of licenses in special situations. SMART is not designed to be used pre-exercise either, so you're right in that you should be using ventolin for this.

Sorry so short,

Cathy

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I switched from seritide to symbicort 200/6, 2does 4x daily (to use in conjunction with various other meds) over a year ago. I have noticed an overall improvement in my asthma and a small reduction in the courses of prednisolone required. I can't offer any info relating to bone densitiy I'm afraid.

From my understanding only the 100/6 + 200/6 are the SMART turbohalers. They contain 2 drugs which are inhaled similtaneously. (Like seritide) not sure if that answers your question or not.

When I started simbicort it did make my heart race a bit but no shakes (only my nebs cause me to shake).

I use a ventolin inhaler prior to + during exercise if needed but use symbicort for other triggers.

Regarding atrovent inhalers + ethanol I don't know (but doubt it). However it is available as a nebuliser solution but I don't know if that would be appropriate for you or not.

Good luck with your scan and hopefully your questions regarding dosage will be cleared up quickly.

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hi c

I had a histamine challenge in february and the results were normal as were all my skin prick test results but my consultant said that due to my history of asthma symptoms he said that a diaognosis of asthma was highly likely, so he officially diaognosed me as having chronic asthma.

i am also on symbicort 400/12 and i take 2 puffs twice a day but i'm not on the smart programme as this inhaler is not lisenced for that. i take my blue releiver when i get asthma sypmtoms.

lejaya

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I'm on symbicort 400/12 and im only 14, and scarily enough seem to be prescribed the same as most adults (up to 12 puffs a day). I must say that personally i haven't found it that helpul, my asthma hasn't got worse but i haven't seen any kind of improvment but thats just me, i know there is a lot of people who its worked brilliantly for. At first i was asked only to take the symbicort but soon came across a problem during an attack i can't breathe in enough to activate it so am back using the blue but this is also because i didn't find the symbicort as helpful as salbutmol during an attack. Good luck i hope it works out for you!

Annie

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Hi C,

Atrovent Aerocaps are listed in the eMC - gelatin capsules containing ipratropium for use in a powder Aerohaler.

tinyurl.com/ykk2kmv

The CFC-free Atrovent inhaler does contain anhydrous ethanol as an excipient but not sure if there are other brands of ipratropium available - one for the medics.

Hope that helps a bit on Question 3,

Ginny