Symbicort not Working Properly?

I have been on symbicort (alternating between 200/6 and 400/12 during flare ups) for the past year, which I know is a combination of formoterol & busesonide.

Prior to this, I was on a clenil modulite inhaler (200mcg twice daily) which I believe was a different steroid (beclometasone dipropionate?)

The switch to symbicort has certainly decreased my attacks of wheezing and coughing which were happening pretty much every time I tried to exercise and at other times in between, I'm a competitive runner and I even broke a rib during a coughing fit after a training session when on just the clenil inhaler and ventolin, not to mention a trip to hospital after a sudden severe attack after a race. This has definitely improved with the symbicort.

The thing is though that for months (I'm not sure how long exactly, but I believe it started just after I switched to symbicort) I've had a feeling like there's mucus in my airway, high up around my throat. It gives me a sensation of drowning when I lie down and it's affecting my sleep, even when propped up on three pillows in bed every night, and my peak flow is dropping overnight to 370 (from a PB of 460). When I do cough I often bring up thick clear sticky mucus (particularly after exercise/ when I get up in the morning). The GP said my chest is clear (but then where's all the mucus coming from!?)

I was wondering whether this is a sign that the LABA in symbicort is helping me, but that the steroid isn't working as it should becasue I really don't remember having this 'gunky' feeling when on the clenil inhaler. I spoke to my GP about this months ago but they were really dismissive, saying that symbicort is a really good drug. I left the doctor's surgery feeling a little stupid, but months later the problem is persisting.

Any advice would be much appreciated.

Thanks.

Jen R

[Hidden]

Hello! I'm also a mucusy asthmatic (the triad is the '3 esses' - swelling, spasm, sputum).

If the mucus is around your throat then it's probably what they call post nasal drip - most people with asthma also have some sinus problems too. For mucus / post nasal drip, the best drug is Montelukast - which your GP can prescribe and is the usual thing that they add next after your steroids + LABA.

It's probably not related to the symbicort / clenil switch, and more that the mould and pollen counts have been at extremely high levels this year - which will affect you in particular as you're running outside a lot. The mucus also then causes coughing which then increases the irritation in your lungs... which then make their own sticky clear mucus as well to try to protect the damaged airways. Chaos!

Obviously it could be something completely different, but that would be my best guess.

It's a shame your Dr made you feel stupid because it's probably something they can help you with. Montelukast has a few weird side effects for the first couple of weeks (headaches and vivid dreams most often) but it's worth persisting with.

Good luck,

Cx

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Hi

I'm on symbicort too and have woken up each

Morning feeling like I have a cold all bunged up and throaty since starting it. Doc gave me a nasal spray called avamys which is flixotide? I think. They give this for nasal drip which I didn't think I had.Since I started using it at night time no more morning cold sniffles. Think it is just coincidence though as I think it's more likely down to high pollen and mould spores in the air as lungs feel clear as the symbicort is doing it's job. Might be worth a try.

Do you get the shakes on symbicort? I shake constantly particularly in my hands it takes so much effort to do a button up,

Type messages on my phone or turn a page In a file. Just wondered if anyone else had the same problem?

Sorry to jump on your thread

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Thanks to both of you, those have been two really useful replies. I hadn't considered post nasal drip but it certainly sounds like it might fit. Maybe I've been too quick to blame the switch to symbicort. I'll try to make an appointment with a different GP and see if they are more helpful.

Scolesey, I also get the shakes on symbcort, though not as bad as when I have to use my ventolin! I notice it when trying to eat peas - they're always falling off the fork and going everywhere lol.

Thanks again Jen R

[cici73]

Initially I was on Clenil but changed to Symbicort 400/12. I was also unconvinced about Symbicort but I no longer get a sore mouth like I had on Clenil. It's worth persevering with.

I agree it does sound like you have post nasal drop which can give you spasms, which are unpleasant and frankly worrying. I've taken doxycycline in the past for PND and it works really well. You could speak to your GP or asthma nurse about PND next time you attend them.

I try not to take my Symbicort around the same time as I drink coffee because sometimes I get shaky and that has helped. I agree that the shakes are unpleasant, they make me feel panicky.

Montelukast has been helpful to me, I still get exacerbations but between these I do feel the benefits of taking it.

It's a shame your doctor made you feel bad, please don't feel that way. It's their failing not yours.

Gap finally I'm in awe of your competitive running. I am trying to get running after a 3 year break. I had asthma then but since then it's become more severe and only this week I got fed up of wishing I could still run and went out and walk/jogged 5k. I aim to continue and you're an inspiration ✨

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Thanks cici. I've made an appointment to see a different GP a week on Monday so hopefully they will be more helpful. Whilst this isn't making me feel particularly unwell it is really annoying me and affecting my sleep, so I'd really like to get it sorted. I wake up each morning feeling bunged up as though I have an awful cold/infection, and I often feel dizzy and light headed, but by mid-morning it's as though some miracle cure has come along and I'm back to normal! This happens literally every morning, and the coughing/bunged up feeling starts again pretty much as soon as I lie down in bed every night. It's frustrating.

Thanks everybody for the helpful replies. I was beginning to wonder if I was just being a hypochondriac and moaning about nothing, so it's reassuring to hear that I'm not alone in having these kinds of symptoms.

As for the running... I'm not at an really high level or anything but I am a member of my local amateur athletics club. I'm currently training for my first marathon. However, my asthma really is mild compared to most on these forums. I've only ever had one severe attack since I was diagnosed 2.5 years ago, and the majority of the time I feel pretty good.

Hopefully you are also able to continue to enjoy your running. Have you ever heard of Parkrun? It's a free weekly timed 5K run held every Saturday in locations all over the UK (and even worldwide). Its a really friendly, no-pressure atmosphere to run in and it welcomes people of all abilities, from the super-fast to those wanting to walk/jog to improve their fitness. And it is stewarded and in the company of lots of people so it's a safer environment to run in than being away out on your own.

Jen R

[cici73]

Hi, thanks for the advice and I'm glad you're seeing a different GP?

Back when I was running I did the 5k 'Run Her' runs a few times and also did the 5.3 mile relay leg of the Belfast marathon. I tried joining the beginners class of my local running club but tbh it was a disaster: I couldn't keep up with the rest of them and I came to the conclusion that they needed to either move all of it's current runners up to the next category or introduce an ABSOLUTE BEGINNERS class. The members took off like hares and I was left behind because although I could run 10k at that stage, due to my asthma it took about 2 k for me to get my lungs opened up enough to run faster. The first 2-3k I'm slow as a cart horse till I get my second wind.

It was a real disappointment and put me off running if I'm honest ?

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Thanks everybody for the useful advice. I went to the docs yesterday and saw a different GP who was really nice and helpful. I've seen her a few times now and she is really good at listening and explaining things. She agreed that we need to do something to get the problems I've been having sorted, but as I am running a marathon in 2 weeks' time, we've decided to wait until after that to start changing things - seemed sensible to me! The symptoms I've been having have really only been at night which is annoying as it's been affecting my sleep, but it hasn't really affected my running, and the doctor said my chest is clear, so she is happy for me to do my marathon, then come back to see her.

She gave me a few options to go away and think about, and to discuss when I go back to see her. She said it may be a case of trial and error to find the best thing for me, as everybody is different. The options were:

1. Switch back to clenil and ventolin - We both agreed this is not a good option as I had a severe attack within the last year and was having frequent coughing/wheezing symptoms when I was taking this. This is why I was prescribed symbicort instead.

2. Stay on symbicort and venotiln and add singulair - I'm not keen on this option as it means a forth medication - I know that's far less than many on here but I really don't want to be taking any more than is absolutely necessary - I'd rather rule out the other options first then reconsider this one.

3. Switch to fostair and ventolin - I think this might be a good option. It would mean taking the same steroid as was in my clenil inhaler (I don't ever remember having the problem with mucus when on that, so perhaps the steroid in clenil suited me better than the steriod in symbicort?) but with the long acting reliever in symbicort which seems to be reducing my coughing/wheezing symptoms (particularly during exercise/ when ill).

4. change back to clenil and ventolin and add singulair (cutting out the LABA) - This also seems like a good potential option. The GP suggested that as my symptoms are mostly at night/ peak flow dipping in early morning (460 down to 370) I might have an allergy to dustmites. It seems strange though, as I was only diagnosed with asthma 2.5 years ago, I'm 22 and I've never had a history of allergies.

So I have a lot to think about before I go back to the GP in 2 weeks' time, but I reckon either option 3 or 4 might be the best ones to try first.

[Hidden in reply to Hidden]

Fostair and montelukast are both good options. I suspect symbicort dislikes you.

[SlimCharles]

I appreciate this is well out of date but i have noticed the exact same issue with symbicort. It is definitely not related to a post nasal drip and i received a similarly dismissive approach from doctors when i brought it up. Im generally a mild asthmatic but ive just moved into a flat quite humid this has made things a little worse meaning ive has to switch back to using symbicort 100 and hey presto, as soon as im back using it, the thick sticky mucus has returned.

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Have you tried montelukast?