What combined inhalers work for you - if you have a heart problem/arythmia

Hello

I had another chest infection in July (during the hot weather) - it flared my asthma up really badly so was on my first course of steroids for 7 days (had awful side effects coming off them as just stopped the 40mg a day no tapering) and in hospital twice, anyway my consultant gave me a new inhaler called FOSTAIR as the QVAR was not stopping flare ups atall.

I know FOSTAIR is a combined inhaler with steroid and long acting reliever in it. I started it on day 5 of taking my steroids which I stopped four weeks ago. The last three weeks I have been having terrible palpitations every day, heavy tiredness all last week and kept coming up with hives on top of thighs.

The last few days the hives spread to my rib area all over and under tops of arms and tops of thighs, went to the DR today and she said it is an allergic reaction to the FOSTAIR (probably the reliever built into it) - I am gutted as my peakflow has improved soooooo much on FOSTAIR to the point I feel near normal again.

I now have been given Seretide but petrified it will interfere with my heart rythm as I have a heart condition already since 2005 of ectopic beats/palpitations and had two failed ablations.

Is there anyone who is able to advise if Seretide or any other combined inhaler works well for them who have a similar heart condition to me atall ? I know we react all differently but feel like I have gone back to square one as QVAR just did not help me before and peakflow was between 250-300 on it wheras my best peakflow was today at 420 which is right for my age and height - it has never been that before.

I am going to go back to QVAR daily until the reaction subsides and start seretide but know QVAR is going to make me have asthma flares again :'''( so any info I will be ever so grateful thank you

Michelle x

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Its tricky having not been in the consultation with GP, but to me it SOUNDS like an allergic reaction to the specific LABA in fostair as opposed to the fact that your particular heart problems were being affected - although im sure if you have an underlying cardiac problem this would be a more significant element of the reaction that it would otherwise have been. If that is the case then i wouldnt worry too much about the seretide, i dont know how similar LABAs are, but i definately noticed a significant improvement wheni moved from Seretide to Fostair and so i could easily imagine that they are differnt enough that a reaction to one does not imply you'll react to the other. that said - you know what you're up against so can be really pro-activly keeping an eye out for allergic type symptoms. LABAs take effect pretty quickly, so presumably an allergic reaction would too??

If you are very concerned about the LABA in seretide then i'd go back to GP and discuss whether it would be possible to build up your dose slowly (starting at one puff of seretide 50 BD and then moving up to whatever final dose she wants you on perhaps??) as i found i got bad palpitations at first on both seretide and fostiar, but my body soon got used to it and i now don't notice anything at all!

I agree, i was never at all controlled on steroid inhalers alone (even when my asthma was very mild i needed the combination inhaler to manage my symptoms) but if LABAs affect you too badly there are quite a few other bits your GP could try, things like Montelukast are often used for kids, there has been some research recently saying that some people who dont respond to LABAs might respond better to montelukast, obviously it depends on you and youre specific asthme (montelukast for example is a good one for more allergic-y people) but just to give you hope that even if LABAs are ot an option for you it doesnt mean that you are stuck having flares!!

HTH!

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Hi,

I have a congenital heart defect which causes low blood pressure and arrhythmias - ectopic beats (PVCs) and tachycardia and have been taking quite a high dose of Seretide for about a year. I don't currently have any treatment for my heart (had operations as a child) because the arrhythmias don't usually cause problems but am regularly monitored.

When I first changed to Seretide, I was monitored quite closely for first few months to make sure everything was fine and this happened when I changed dose from 250 to 500. This is quite normal for me though when they introduce new inhalers that can increase your heart rate as I struggle to keep my pulse below 100 anyway. So far it has only been Ventolin which I have a problem with as, although it doesn't cause any symptoms, my pulse gets up to 200.

Like you say, we are all different in terms of reactions to meds and heart conditions so I would speak to your doctor if you are concerned.

Hope this helps

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Hi,

I have a congenital heart defect which causes low blood pressure and arrhythmias - ectopic beats (PVCs) and tachycardia and have been taking quite a high dose of Seretide for about a year. I don't currently have any treatment for my heart (had operations as a child) because the arrhythmias don't usually cause problems but am regularly monitored.

When I first changed to Seretide, I was monitored quite closely for first few months to make sure everything was fine and this happened when I changed dose from 250 to 500. This is quite normal for me though when they introduce new inhalers that can increase your heart rate as I struggle to keep my pulse below 100 anyway. So far it has only been Ventolin which I have a problem with as, although it doesn't cause any symptoms, my pulse gets up to 200.

Like you say, we are all different in terms of reactions to meds and heart conditions so I would speak to your doctor if you are concerned.

Hope this helps

Like Kayla, I have been on seretide now for about 4 years and I have chronic tachycardia with atrial fibrillation. But they keep an eye on it and I've never had any adverse heard reactions to the seretide.

It may be a case of trial and error, but I'd speak to your consultant and maybe consult a cardiac specialist about it aswell.

HTH!

Vicky xxx

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Hiya I have diagnosed SVT - have had it for years, and cardiac ablation was unsuccessful. I take fostair and tiotropium (spiriva), 5mg salbutamol nebs and theophylline. I used to be on seretide. None seems to trigger additional episodes of SVT as I havent seemed any worse with them - obv the theophylline, salbutamol and to some extent the spiriva do increase my heartrate slightly.

I take verapamil PRN if I have problems and also if I need IV aminophylline - this was introduced after a heartrate of 230 bpm for 3hrs which sent folk in A+E into a flap LOL.

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I take verapamil PRN if I have problems and also if I need IV aminophylline - this was introduced after a heartrate of 230 bpm for 3hrs which sent folk in A+E into a flap LOL.

I regularly have this problem - often they are more worried about my heart rate than the fact I went to a&e for my asthma.

Out of interest Nursefurby, did they have any queries/concerns before starting Theophylline? This has been mentioned several times by my GP and a reg who I first saw earlier this year. I was told that it would probably be quite effective as I respond well to steriod treatment. However, my cons was very reluctant because of my high heartrate (usually about 100-120 at rest). Ventolin does make this worse which is why I take Bricanyl. Therophylline is still on the cards but atthe bottom of a very long list to try. I have an appointment with my cardiac cons next month so was going to ask for his opinion on it.

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I regularly have this problem - often they are more worried about my heart rate than the fact I went to a&e for my asthma.

Out of interest Nursefurby, did they have any queries/concerns before starting Theophylline? This has been mentioned several times by my GP and a reg who I first saw earlier this year. I was told that it would probably be quite effective as I respond well to steriod treatment. However, my cons was very reluctant because of my high heartrate (usually about 100-120 at rest). Ventolin does make this worse which is why I take Bricanyl. Therophylline is still on the cards but atthe bottom of a very long list to try. I have an appointment with my cardiac cons next month so was going to ask for his opinion on it.

Hi Kayla, my normal resting heartrate is around 120. I find that resp consultants are far more anxious than cardiology consultants about heart rate. Though granted they have never been overly worried about my general tachycardia (as obviously its a common side effect of the meds Im on, so its not without reason) - but the SVT stresses them out haha. The cardiologist at Papworth who did the failed ablation took a pragmatic view that we needed to keep the resp consultants happy so that my lungs could be treated effectively, hence the verapamil. He wasn't dismissive - not at all, its understandable that a non cardiologist is going to worry more about these things than someone whose specialty it is. SVT in and of itself isn't dangerous particularly - just bloody uncomfortable when you're having a severe asthma exacerbation and your heart rate is 230! Its exhausting.

Regarding the theophylline, it doesn't seem to have increased my episodes of SVT. I think the issue is getting the dose right, startlng low and having levels checked early. I get toxicity at very low doses and am only on 60mg BD which for me places me in the therapeutic range. I remember years ago they started me on 200mg BD and I seriously thought I was dying - now I know why!

If respiratory bods are anxious, the best thing to do is to get a cardiology opinion re the theophylline, its quite likely they wont have an issue with you trialling it. Your resp consultant should be able to liaise with them about it.

Lynda

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I do not have a heart problem but a heart monitor did pick up some abnormalities but I've been told its nothing to worry about.

I was on seretide (and Qvar) before the inhaler I'm on now. I did not find Qvar as good as seretide but when I got bad last winter I was on both. I found I got heart palpatations whilst taking both but not unbareable ones. However I am on symbicort at the moment and this seems to be so much worse, last night my heart would not settle for around 3 hours, resting heart rate was 93 which I feel is very high for me and heart felt very uncomfortable, like it was fluttering and it is Impossible to get to sleep with this!! anyone else found this with symbicort (200/6) I was taking 4 puffs in morning and night as have quite a lot of symptoms lately. I have dropped it to 3 as of this morning as I do not want my heart doing that again and have been fine (think I have turned a corner with asthma this week).

I also find when I take more salbutamol I got them a lot more.

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In the past I've been on seretide, symbicort and am currently on fostair. All of them have increased by heart rate, but then that's a common side effect anyway I think. Salbutamol also does this plus the unuphylline I take. My heart rate during an attack can go above 170 (when the drs panic!).

I dunno if this is helpful, just want you to know you're not alone!

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Thank you Lynda, I haven't seen my cardiac cons (who is also at Papworth since my asthma really kicked off again so it would be interesting to get her views on it. I do find that she is more laid back with arrhythmias as, with my cardiac history, it isn't really a problem but a&e and my asthma nurse seem to flap a bit (especially of I have had to have Ventolin!) They only keep an eye on it because they are caused by a congenital defect. I will ask her about it at my next appointment as I do think it has more potential to help than all the other things we have been trying (which my GP described as whacky experiments).

Thank you for your help.