Posting for my Dad - Symbicort 200 Turbo Vs Fostair

[KikiRW]

My Dad was diagnosed with Asthma in 2013; he was 55. After a bad chest infection, they trialled him on Clenil and Ventolin and these were not effective. He ended up having an Out of Hours appointment and the GP put him on Symbicourt, no ventolin. He was told if he had an asthma attack, he was to call 999.

For the past 2 years he has found this to be problematic. He struggled to realise when he has taken it (for one week he was taking an empty inhaler!) and he is always suffering from a cough in the mornings. Recently he has had a relapse and has had several. He has had take an emergency ventolin inhaler and increase his doses of symbicort. He is taking Symbicort x 3 times a day, and ventolin whenever he is out of breath, which is x2 a day. When he is asleep, he is wheezing so much my Mum is waking him up to resposition himself. He says he feels "like he can't fill his lungs up". He always suffers from a dry mouth. His peak flow is 800!!!!!!!!!!!!!!! His peak flow during his relapse is 650, on a good day I'm 400!!!!!

I'm a community nurse - but sadly no experience in respiratory! I spoke to my respiratory nurse who has recommended fostair. Mum & Dad have spoken to asthma UK and done their research, they appear to be happier with this inhaler as they feel the symbicort has never suited my Dad. Has any other asthma suffers done the switch? My only concern is that it is winter, and my parents go on holiday to the seaside often where it is always cold!

My Dad is 57, a non-smoker who is a landscape gardener - he spends his entire life outside carrying things as heavy as me! There is a family history of asthma; I'm asthmatic and have been for 20years. His Mum, Auntie & Grandma were diagnosed in their 50s. Help!

[starveycat]

Hi cannot be of much help but am sure someone much wiser will be along soon,just a thought about his breathing at night is the bed head raised so he does not sleep flat as that could help him

[servewithmintsauce]

On the Fostair front, just remember that whatever anyone says about it being 'double-strength', Fostair 100/6 is only equivalent to Symbicort 200/6, so..but yeah he might well be better with an MDI (puffer) than a DPI (dry-powder inhaler), just make sure he gets a spacer as well (plastic tube which goes in your mouth at one end and the inhaler goes in the other end, means you get the maximum amount of med in the lungs).

As for a peak flow of 800 L/min, of course everyone is different and by no means does that mean he doesn't have really bad asthma but..myyyyy gosh I'm still waiting for my peak flow to normalise to 350 L/min! XD

[KikiRW in reply to servewithmintsauce]

That's great, thank you! I personally hate the spacers and never had one, while my dad feels as if he's getting "more medicine" and I encourage him to use it when he can. Thank you for the fosair advice, I know so little about asthma except for my own.

[servewithmintsauce in reply to KikiRW]

What do you use for your asthma?

[KikiRW in reply to servewithmintsauce]

I'm on clenil 200 and ventolin 200, I've been on that since I was 7 😂😂 I had pneumonia last winter though.

[servewithmintsauce in reply to KikiRW]

Ahh I remember Clenil. I hope it helps; pneumonia sucks!

I didn't realise you could get Ventolin in 200mcg/dose?

[Annista]

I know this is probably a silly question but, as it sounds as it he's so ill, has he seen a consultant or had any sort of second opinion? It's just that I find it very hard to get my head round the fact that he's got such an amazing peak flow and I'm wondering if there's anything else going on as well as (or instead of) the asthma.

[KikiRW in reply to Annista]

I strongly believe my dad has sleep apnea; he wheezes, snores, falls asleep quickly and my mum says she thinks he's not breathing and wakes him up. I've spoke to his GP about it and his GP has put it down to Dad being exceptionally fit and that's why his peak flow is stupidly high. I beg to differ but hey, I'm just a nurse! He's had chest X-rays and bloods (my requests X-D) which have come back clear. He has an appointment on Friday, and I'll mention the sleep apnea again.

[servewithmintsauce in reply to KikiRW]

It can be the case, certainly, that a very fit person would have a high peak flow. I play ice hockey and have seen my personal best go from 310 to 350 in just a year, despite worsening asthma control and more and more add-ons. So that is possible. However, it is no clause for dismissing sleep apnoea, don't know what your GP is on haha

As far as I'm aware, clear x-rays and bloods are usually a good sign, especially so if his spirometry didn't show any kind of 'restrictive' pattern, which I'm assuming it didn't. It likely means he doesn't have an infection (in the absence of other signs of one), and rules out to a large extent tumours, cysts, fibroses, effusions, etc..

The description you have given points to sleep apnoea, and nothing rules out asthma as far as I can see based on what you've said. Uncontrolled sleep apnoea can make controlling asthma difficult..so I would pursue this line of enquiry, as you are. If your GP keeps dismissing it, find another one! I would suggest you look up the dangers of uncontrolled sleep apnoea (not to freak you out, don't worry) and hammer these home to your GP. Riiight home.

Good luck, and tell us how things go if you can

[Annista in reply to KikiRW]

That makes a lot of sense. The sad truth is that some doctors see asthma and asthmatics as a bit of a nuisance and symptoms like your Dad's are dismissed as imaginary or attention seeking or (even worse) panic attacks. Good luck with it, and don't give up.

[TuckBox2]

I have been asthmatic for 30+ years, I also have sleep apnoea, I used to stop breathing 90+ times per hour. I now have to use a CPAP machine when I am sleeping and I find this is a great help. You'd be best trying to get your dad to see a sleep clinic, it did take a while before I got my appointment, I had to keep hounding them.

I was at the chest clinic yesterday, they putting me on Fostair, my daughter works in her local hospital and told me about this last year, my clinic are now switching a lot of people over to this. So I will have to see if it helps me.