I was hospitalised just over a week ago with a life-threatening asthma attack after 4 weeks of being on Fostair 100/6 and not having proper control. I should only have been taking a maximum of 2 puffs twice a day but I had to increase it to 3 puffs twice a day and my control was still suboptimal. I was changed to Fostair from Symbicort (200/6, 4 puffs twice a day) by the asthma nurse I don't usually see, on the premise that '"it's double-strength anyway", because I didn't like the DPI device. This was the same nurse who, only a couple of days prior to my admission, had asserted that -- despite my horrible cough -- I was "not wheezing so that's a good sign" (I don't wheeze, ever, and have told her this multiple times), and "not at any risk of another hospital admission"; that I "need to give the Fostair time to work" and that I "don't want to be on high doses of steroids". She was obsessed with getting me on lower doses, and seemed to think my asthma was controlled, despite my chest tightness, breathlessness, cough, and dropping peak flow readings.
After much deliberation, the doctors here at RBH said that actually, they can prescribe Seretide, but they have to fill out a form and decide it with a panel, on a case-by-case basis.
And my case has been accepted!
I had really good control with Seretide before, so I'm happy. I will be using Seretide Evohaler 250/25, 2 puffs twice a day, as of this evening. I think I am also getting a Flixotide inhaler to use when I am in the yellow zone, instead of stepping up both components.
It's small. But it's important.
-- Matt
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Thanks I hope it didn't seem like bragging because I know loads of other people have been changed off Seretide when it was working well for them..maybe this post might prompt some other people who are struggling to ask further questions?
I didn't know seretide was restricted. I have separate serevent + flixotide inhalers as I take 2puffs serevent bd & 4puffs flixo. Couldn't you have separate ones? My asthma nurse is an idiot, I refuse to see her.
Yes; pharmacies, doctors, and health organisations or regulatory bodies have been phasing Seretide out in the UK due mainly to an increased risk of pneumonia and also due in part to cost (but not entirely; other combinations available are slightly safer but more expensive).
I could indeed. I prefer having the combination though, as I have to do my morning inhalers on the bus to college or train at weekends, so this reduces the number of inhalers I have to take and the amount of time it takes me to do them all What dose of Flix are you on?
She's unimaginative but has a high opinion of herself. My gp is great tho. I'm on 4puffs of 250 flixo, bd. Con is thinking of swapping me to symbicort for a trial pd. Going on montelukast & spiriva has helped
So there isn't actually a fixed-dose inhaler that fits your needs anyway, which is a shame. Although Symbicort is more flexible than Seretide because it has formoterol instead of salmeterol, so yeah actually I guess that would theoretically work, so long as you like the device But if you're like me, so long as you can breathe, everything else is secondary! Of course, I'd rather be on no meds at all but when it's the choice between being able to breathe properly and live a relatively normal existence, or be on low doses or no doses and have a very restricted life, I know which one I would rather have any day.
I don't use Spiriva, but I use Montelukast and Atrovent. Even when I was uncontrolled on the Fostair, I could feel a very distinct difference with the Atrovent; 1 out of 3 times I went to ice hockey, I forgot to take Atrovent and that session was really not good. Hopefully I can get more control with the Seretide, and will really feel the benefits of Atrovent for ice hockey! Montelukast was a real turning point as well, but like all things since my diagnosis, it only worked for a bit, until I needed stronger stuff :/
They tried me with serevent and it just made no impact at all. I took myself off it in the end. I rely on flixotide 250 (and ventolin when I need it) to keep my asthma under control.
Really pleased to hear that they've put you back on medication that works for you. Common sense seems to have prevailed at last
Have you tried any other long-acting relievers, like formoterol? Or are you actually completely controlled on just the steroid?
Gosh yes so am I. So pleased. It has been a few months since I was last on Seretide though, so I cannot be entirely sure it will work now..but this is a higher dose than I used to be on, so I have high hopes. Crazy as it sounds, I honestly don't think I've ever been this excited to get a new inhaler!
I'm just completely controlled on the steroid, but there is seasonal variation when it comes to amount taken. In the summer months I usually only need one dose morning and evening. Last winter I managed on one dose morning and two evening, which is what I was on until last week when my peak flow began to drop. I'm now on two doses morning and evening and my peak flow is holding steady.
Last year I was having frequent exacerbations and the asthma nurse weaned my Seretide 125 to 1 puff BD even though at the time of the appointment in June I'd had exacerbations in December, April and June. GP had to change up to Seretide 250 2 puffs BD which I'm still on; I add in extra Flixotide when drop below 80% of best. Not completely controlled; currently on 3rd exacerbation this year and have been in hospital twice this year but things could be worse; I had more exacerbations this year. Think there has been a lot of swapping from Seretide to Fostair due to cost but the change isn't going to suit everyone.
The no wheeze thing is really irritating I only wheeze when I'm not that bad or when I'm getting better and have better air entry. Got a good respiratory consultant now which really helps!
I despair of people being told by the medical staff that as they are not wheezing but coughing they are O.K.
I have had cough variant asthma all my life and have been told that I am fine as not wheezing so many times when I have been really struggling and often with a very low peak flow.
UNBELIEVABLE! It was the same in the 1960's. You would think that 50 years later medical personnel would know better. My sympathies. You know how you feel and how you are breathing! Is the nurse in question an asthma nurse?!
I used to be on Seretide but am one doing well on Qvar and Montelukast with ventolin as required.....about average of twice a week ventolin with more at certain times of year or situations such as a cold etc.
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