Fostair

[loulouliss1]

Is Fostair 100/6 four times a day (8 times on my asthma plan if I’m bad) considered a high dosage steroid or low?

[Scoobs87]

I’m on 200/6. And I don’t feel it’s doing much for me. X

[Scoobs87 in reply to Scoobs87]

I am also on montelukast and the nurse said that there’s not much else they can try. X

[Chip_y2kuk in reply to Scoobs87]

I'd find a different nurse... there are a number of different inhaled steroid long acting bronchodilator combination inhaler combinations

Fostair is the logical choice after the brown one (clenil/qvar which is just beclomethasone on it's own) as fostair is beclomethasone and formoterol

It's also the next cheapest inhaler for the doctors to prescribe and had a big marketing push from chesi as the next best thing to sliced bread

But there is seretide which is fluticasone and salmeterol among about 10/12 others

I liked fostair but sadly after a while it didn't work for me and I ended up in an unpleasant way in urgent care not able to breathe or stop coughing

[Scoobs87 in reply to Chip_y2kuk]

I’m not doing very much but still feel knackered. It’s been that bad. I’ve been off work since middle of November & got taken into hospital on 17th Dec. My peak flow is up and down like a yo yo.

[Chip_y2kuk in reply to Scoobs87]

I tried seretide and liked it it made a massive difference to my breathing but couldn't sleep with it it gave me insomnia so me and my doctor decided we would switch to a lower dose and my asthma started acting up slightly so I made a call and ended up on duoresp spiromax but no also take braltus once a day which has made a massive difference (but the nhs don't like prescribing it for asthma as it's really expensive to the nhs... But so is me visiting very week so they can prescribe it and like ti)

[Scoobs87 in reply to Chip_y2kuk]

This is going to sound terrible, but it’s life saving for us. But the can put millions into drug rehabilitation and some of they people don’t want the help. Xx

[Chip_y2kuk in reply to Scoobs87]

A lot of doctors don't know much about it as it's usually used by COPD patients but is used for asthma where a long acting broncnodilator (LABA) have proved effective but control still remains inadequate they use braltus (LAMA).. you also need to have had one or more courses of steroids... and it costs the nhs 60 quid a box which is a month supply

[Scoobs87 in reply to Chip_y2kuk]

I’ve had 3 courses prednisolone since November. Last course was over 100 tablets over 3 weeks. Xx

[Chip_y2kuk in reply to Scoobs87]

Have you had allergy testing?... the gp can order a total Ige count...This tells them if you have an allergy but not what too... if it comes back high they can stipulate a range of allergens (normally aeroallergens) to be tested.. aero allergens include dust,molds and pollens they can do all of that from the same blood sample at the same time

[Chip_y2kuk in reply to Scoobs87]

I'm on 6 in 9 maybe 10 months but only ever have a 5-7 day course of between 30 and 50 mg to get me out of trouble and usually double my inhaler before during and after the course for a while to keep me that way

[Scoobs87 in reply to Chip_y2kuk]

Everything just seems trial and error just now. This is the first time in years I’ve had to use a spacer aswell.

[Chip_y2kuk in reply to Scoobs87]

It's frustrating and frightening though when my asthma came back to life I ended up in urgent care being told I potentially had a blood clot on my lung or a problem with my heart as my main and only real symptom was an uncontrollable cough and tachycardia... I spent months waiting for a referral to a heart specialist... only to be sent to a respiratory specialist and the k God my gp did send me there even though I hadn't used an inhaler in 7 maybe years

[Scoobs87 in reply to Chip_y2kuk]

I have chostochrinditis, which is inflammation in the chest. Then a flair up of asthma. So this has been with me since Oct but got progressively worse from beginning of November. Last sat and Sunday. The chostochrinditis flared up and had nothing but chest pain, since it’s settled down, I’ve been more breathless again.

[Chip_y2kuk in reply to Scoobs87]

Ive had costochondritis and the doctor said the best cure for it is nsaids and after years of taking them without issue I found out last year I have to avoid them now... the hard way

[Scoobs87 in reply to Chip_y2kuk]

Do you still have chostochrinditis, I am finding it hard to deal with at the minute, the strongest pain killer I can take us cocodamol. I am on baclofen muscle relaxant and dihydrocodeine at the moment, it seems to be working for now, but don’t know if that’s what’s causing me to be more wheezy last couple of days.

[Chip_y2kuk in reply to Scoobs87]

No I took pain killers when it was bad and just plotted on it was hard to distinguish what was costochondritis and what was asthma as I also had a lower peak flow so was convinced one was impacting /worse ing the other

[Scoobs87 in reply to Chip_y2kuk]

It’s hard to live with both. Has yours gone away, doc told me it would only last 6-8 weeks.

[Chip_y2kuk in reply to Scoobs87]

Yes it appears to have although It did happen a few times before the doctors decided it was costochondritis

[AnnieAnnieAnnie in reply to Chip_y2kuk]

Braltus or tiotropium is liscenced for asthma if still uncontrolled and having exacerbations. It's not used as much because you're on step 4 of the British thoracic guidelines. But it can certainly be prescribed and can work very well. It is widely prescribed for COPD .

[AnnieAnnieAnnie in reply to Scoobs87]

Have a look at the British thoracic guidelines for asthma and see your options

[Scoobs87 in reply to AnnieAnnieAnnie]

I will do

[Hidden in reply to Scoobs87]

I’d ask for a referral to a chest physician!

[AnnieAnnieAnnie in reply to Scoobs87]

Have you tried the MART? (Maintenance and reliever)

[Scoobs87 in reply to AnnieAnnieAnnie]

Never tried mart.

[AnnieAnnieAnnie in reply to Scoobs87]

I'm an asthma practice nurse. I look on this site and do many people have uncontrolled asthma.

Can you speak to your asthma nurse. If one inhaler isnt working there are others to try or different regimes to work with.

Sometimes it's trial and error to find the right one for you

[Scoobs87 in reply to AnnieAnnieAnnie]

I’ll do that. I take fostair and montelukast, but I’ve been having a flair up since November really, been on 3 lots of prednisolone, and got taken into hospital on 17th Dec.

[Hidden in reply to Scoobs87]

Fostair 200/6 just didn’t help me. I’m now on Relvar ellipta and it’s brilliant. It’s a powder you suck in once a day so far easier regarding compliance and convenience. There are 2 strengths, I’m on the higher and it has kept me well. xx

[Scoobs87 in reply to Hidden]

I might see about that. At the moment I’m breathless and I’ve just got out of bed

[Hidden in reply to Scoobs87]

That’s just not acceptable. You deserve better. Breathing is fairly necessary!! I can’t express how you ought to push for better care. Difficult to do when you’re not feeling great but ask for a referral. Xx

[Chip_y2kuk]

8 puffs of fostsir a day is the most you can take... pretty sure it's the beclomethasone (steroid In it) that dictates that number as I'm on duoresp and am currently taking 8 puffs but the max is 12 and it's the same laba (formoterol) but the steroid is different (budesonide)

[Chip_y2kuk]

I also know they do a 200/6 but the maximum puffs in that is 4 so it's the same amount of beclomethasone but less formoterol

[Chip_y2kuk]

The thing with ics dosing is it's a trial and error thing... My prescription says 1 to 2 puffs twice a day but I know ow from experience that taking one puff of any ics I've had previously leaves me very breathless very quickly (I'm on my 5th combination inhaler in 18 months)... and my gp is happy to leave me to it and when it's getting out of hand I give them a call and it usually results in a course of prednisolone

[loulouliss1 in reply to Chip_y2kuk]

My gp has put me on 4 puffs a day and tells me to bump it up to 8 a day when I’m bad but to also see her straight away because my attacks have always been severe, she says 8 puffs is the equivalent of 200/6 Fostair but I find it makes my hands shake.. as an artist this is difficult, it’s awful !

[Chip_y2kuk in reply to loulouliss1]

The formoterol can cause hand shaking (long acting bronchodilator) as can any broncnodilator ... it might be worth asking can you switch to 4 puffs of the 200/6 because of the shakes on a trial basis as you'd get the same amount of steroid but half the amount of formoterol

[Chip_y2kuk]

Or switch to a beclomethasone/salmeterol combination

[AnnieAnnieAnnie]

Fostair as a MART ( maintenance and reliever) should be a 200/6. Max 8 times day. Discuss this with your asthma nurse. ( Not 100/6)

800mcg daily you are taking. Can go up to 1000mcg to 16Oomcg safely.

To be honest if you need it it is better to take it and have controlled asthma

[mmmp4cj2 in reply to AnnieAnnieAnnie]

Dear Annie- I would double check the above post as I think you have made an error. I am a GP. Remember 100mcg ultrafine BDP in fostair is equivalent 250mcg normal BDP therefore 8 puffs fostair 100/6 is 2000mcg BDP i.e. The top of the asthma ladder.

The last I checked fostair 200/6 does not have MART license and certainly not at 4 puffs twice day. ( 4000mcg beclomethasone equivalent) .

The asthma professor who looks after my severe asthma has me on 4puffs twice daily 100/6 rather than the more conventional 2 puffs twice daily 200/6 option as the extra formoterol can help some people but it certainly can give you a tremor!

[AnnieAnnieAnnie in reply to mmmp4cj2]

Hello.

Fostair 200/6 has been iscenced as a MART for a few years now. Max 8 puffs day

It is fine particles so many asthmatics do not need to use as much to have asthma control. So on maximum doses it would be on the high end of inhaled steroids use

However the great thing about MART is that a person can step right up if needed and step right down when it it is required.

A course of oral steroids is equivalent to approx 1 yr of inhaled steroids so much better to be controlled on inhaled steroids.

lts all about tailoring individual needs to control asthma in the end. It can work very well. But there are many different options.

Formetetol as any long acting bronchodilator can have side effects. Insomnia and tremor being two.

I'm a practice nurse/ asthma nurse x

[AnnieAnnieAnnie in reply to AnnieAnnieAnnie]

Sorry I am a twit. You're right if course. MART is100/6

[AnnieAnnieAnnie in reply to mmmp4cj2]

Oh gosh sorry . Completely wrong100/6 is MART.

What a twit I am this Sunday morning.

[mmmp4cj2 in reply to AnnieAnnieAnnie]

Sorry just read 2nd post- thanks for correcting Annie !

[AnnieAnnieAnnie in reply to AnnieAnnieAnnie]

Apologise. Yes fostair is fine particle so is a higher dose..

[mmmp4cj2 in reply to AnnieAnnieAnnie]

Annie I'm sorry to put a conflicting post but I think it is important to give correct/factual information to people. Fostair 200/6 doesn't have MART license - please recheck the literature it's the 100/6 that does and has for several years. 200/6 only has maintenance licensing as per the upto date BNF and the max dose is 2 puffs twice daily.

You are right ICS have way less systemic side effects than pred but 4000mcg BDP equivalent in 8 puffs 200/6 fostair may have significant systemic side effects and is not a safe licensed dose- I certainly would not be recommending this to any patient.

Historically before biologics some asthma consultants used to use up to 2000mcg fluticasone (4000mcg BDP equivalent) but this was off license and should only be done by a specialist under careful observation. I think most asthma specialists these days rarely go much above 2000mcg as the systemic s/es above this dose can become very real- including adrenal insufficiency, cataracts, reduced bone density etc

[Lindslou]

My GP told me my 200/6 Fostair was the high end of normal. Maximum dose of steroid per day is 2000mcg

[PPxwoods]

Fostair 6

A dosage of 8 eight would be equivalent

to 20 dosage of this steroid in a normal format

But because it is delivered as a very fine powder in the inhalation

8 by 100 is sufficient

However this dose is tiny in comparing

with 1 oral steroid

Of 5mg of prednisone ( only 20%)

So if you can control your asthma with Fostair

it is much much better than taking oral steroids

Fostair also contains a bronchodilator

( reliever)