Long acting beta 2 agonists or inhaled steroids only ?

[Hannah125]

Hi!

As I've posted here before I've been suffering from an asthma exacerbation for 5 months now and I am still struggling to get it back under control. I am currently finishing a second short course of oral steroids and I'm also using seretide 250 (4 puffs everyday). The majority of the doctors I went to see didn't help me : they immediately put it on the count of anxiety because no wheeze and good sats so they say it must be in my head!

As I've mentionned, I'm currently taking seretide but I'm concerned about the potential side effects. I did some research trying to figure out the most effective treatment to bring my asthma back under control but I've found that long acting beta 2 agonists (LABA) could potentially lead to deadly asthma attacks. They apparently reduce the effects of salbutamol (rescue inhaler) so it becomes less effective. I also read that they should only be used if inhaled steroids only didn't work and for those who have bad spirometry results. I happen to have normal spirometry results so shouldn't I be using the inhaled steroids only ?

Thank You!

[Js706]

Most of the studies that showed the issues with LABAs were when they were used as a monotherapy - so without any inhaled steroids alongside them. Which is the main reason they’re now pretty much only available in combined inhalers. When the two are used together the research generally says that the benefits of the therapy outweigh any risks.

They are normally used after trying inhaled steroids only but it might vary slightly depending on how bad a flare you have/what GPs prefer to prescribe - if someone is needing multiple courses of oral steroids some may go straight onto a combination inhaler to try and regain control.

I’ve not come across the point about spirometry. But spirometry is often normal in asthmatics as it’s a variable disease. For example, I have a diagnosis of severe asthma and am on most meds available for it, but most of the time my spirometry is completely normal, so that shouldn’t normally be a reason to not step up medication 😊

[Junglechicken]

I’ve been having similar problems with my asthma. I am on 2 puffs a day of the Seretide 500 and i’ve moved from having asthma that is 90% under control to having a permanent cough and tightness. PF pre inhaler is around 75%, which improves after the Seretide. GP’s at my NHS surgery have told me it’s anxiety. So fed up with the situation I went to a private GP to get a second opinion. He recommended that I see a respiratory specialist to investigate all the possibilities such as severe hay fever or a lingering infection. Have to admit I’ve not been anywhere today and my breathing is so much better. It seems that many of us are struggling to get the treatment we need through the NHS. I’m very lucky that my medical insurance is covering the cost of going private but not everyone is as fortunate.

[Hannah125 in reply to Junglechicken]

I'm sorry you had to go through all this. I'm still surprised to see how much we have to fight in order to be taken seriously and to get appropriate treatment. Asthma is a very scary disease and I think we deserve better care for it. You mentionned you were also using seretide, how long have you been using it ? I'm not really sure when it starts to work, I took it for 3 weeks but noticed no change.

[Junglechicken in reply to Hannah125]

I’ve been taking Seretide for about 3 weeks also. So far the Seretide holds everything in check for about 6 to 7 hours which is way below the 12 hrs it claims on the packet. It’s a big improvement on having to take salbutamol every 3hrs, which at times hasn’t relieved the symptoms with just 2 puffs. Just as an update I went out this morning and my breathing is laboured and have a wet cough again. Really starting to think it’s really bad hay fever that’s irritating my asthma.

[krylan]

Hi there! Sorry to hear you’re struggling with your asthma. The first course of meds for asthma is an ICS which is an inhaled corticosteroid only and if that doesn’t work (which it didn’t really work well for my “mild “ asthma) they will put you on a combo inhaler that is an ICS AND A LABA. Which will take care of the inflammation (ICS) and keep your lungs open (LABA). These combo inhalers no longer come with a warning as the deaths were due to using LABAs alone. They’re safe as long as they’re with an ICS. Have you ck to see if you have digestive issues which is the cause for 85% of most adult onset asthma? Try eating smaller meals, take vitamins and heal your gut. Slow breathing is good too. Do some research on asthma and your gut. Good luck!