Idiots Guide for Preventer Medication

[Noddy66]

I am coming up to my Annual Asthma Review and am looking for guidance regarding medications. I was diagnosed with exercise induced asthma 30 years ago and had several hospital admissions for pneumonia around that time. Overall been well though and played rugby till I was 62. All that time was on preventer medication Clenil and latterly Relvar. Currently on Clenil Modulate again as I thought Relvar was causing nasal congestion. This has proven to be a bad move and PF previously 550 now averaging 400/450 using salbutamol plus plus currently on prednisolone after PF fell to 250 bringing up huge amounts of mucous and had the worst asthma attack I've ever had. In retrospect the Relvar was protective so maybe I should go back on it. I see so many drug names on here so was wondering if there is any guide to which one to take so I am well informed when I have my review.

[EmmaF91 Community Ambassador]

Hi

There are lots of different preventer drugs but only 3 main corticosteroids are used (beclometasone, budisonide or fluticasone fuorate). Some inhalers are solely a steroid, others are combined inhalers and have a long acting beta2-agonist (LABA) in the medicine. This is usually the 2nd named drug (formoterol is the usual one or vilanterol). You also have the option of dry powder (DPI or suck inhaler) or the normal metered dose (MDI or puff inhaler).

Each combination has a different name, plus some are branded and others are generic so different names again. There are also different dosages (ie fostair 100/6 vs fostair 200/6 etc).

There is also the option of a tiotropium or atrovent inhaler which is a anticholinergic inhaler with no steroid, or an inhaler with just a LABA (severent which is salmeterol, or Foradil which is formoterol).

Finding the right preventer inhaler(s) for you is usually trial and error, however sometimes you can ‘strike off’ an entire group - for example I can’t use budisonide as I’ve tried a few different inhalers with that steroid and always got side effects so now I avoid it.

If you don’t feel like your preventer is working or keeping you controlled it’s either time to try a different one, or time for them to up the dose you’re on.

Here’s a link to a slightly out of date page which lists some of the different inhalers and what they’re made of (I’m pretty sure the option list is slightly bigger now as this is 2 years out of date but 🤷‍♀️);

gmmmg.nhs.uk/docs/guidance/...

Hope that helps clear things up a bit, and isn’t too confusing! X

[Noddy66 in reply to EmmaF91]

Cheers Emma that guide is very helpful. I'll study it before I go to my Asthma review. Thanks John 😎

[risabel59 in reply to Noddy66]

As Emma said those are the main preventer steroid medicines. But there are some others, I use Alvesco, which is ciclesonide, it’s the best I’ve ever had in 40 years of using preventers. Currently it doesn’t come as part of a combination inhaler. However I use a combination LABA /LAMA inhaler as well. Which contain long acting The bronchodilator and Long acting Muscarinic antagonist.

There are also some newer steroids coming through. Importantly it’s good to use a steroid inhaler which has small particles and low bio availability, particularly if you use high doses.

It’s crucial with Meter dose inhalers (MDI’s) to use a spacer, it increases the amount of medication getting to your lungs by about 50%. (If you use it correctly). Asthma UK have a good video about spacer use.

Also you need to make sure that you get the right spacer for your inhaler. It normally tells you in the drug information leaflet. If you are uncertain about this you should ask your asthma nurse at the appointment.

Dpi (dry powder) inhalers don’t require a spacer, and there are some good choices here.

I think over the years one thing I have learned is that different drugs suit different people. But when you dial down on it the most important thing is to take them all the time. Not just when you feel unwell

Best

R

[Thomas45 in reply to risabel59]

I was changed to a Dry Powder Inhaler. I think it was a cost cutting measure but it has turned out to be the best preventer I've ever had in the 44 years since first diagnosed with asthma. It's Duoresp Spiromax 320mcg/9mcg of budesonide and formetrol fumarate dihydrate. I get through 2 a month. I don't need to use my salbutamol inhaler very often, normally once or twice a week.

I caught the latest common cold recently. Most people got over it in a couple of days days. I didn't. After a week it had turned into clogged infected sinuses and lungs. Although I increased preventer doses as advised by my doctor when I realised that it wasn't going away I rang the medical centre, saw a doctor within 2 hours and the prescribed antibiotics and steroids are now working well.

[mariyn in reply to Thomas45]

What were you on before ? I have been on SIRDUPLA for 4 years and it is now almost not working for me Best Marilyn

[Thomas45 in reply to mariyn]

Symbocourt Turboler 400/12. According to the guide for health professionals each delivered dose is actually the same as my dry powder inhaler 320/9 of the same chemicals. As someone's already mentioned we don't all react to medicines the same.