Relvar ellipta, Montelukast should I be shielding?

[Londonliving]

Hi,

I know there have been a lot of similar questions but with the ever changing advice I’m feeling utterly confused.

I take Relvar Ellipta 184/22, montelukast and salbutamol as needed. From what I can figure I think that means I should shield? Interpreting the guidelines when you don’t know the medication names is hard work.

I haven’t had a letter or anything but it was decided that I should work from home from today as I am a frontline health care worker in critical care (I’ve not been on the wards for a week prior to that.) I have horrendous guilt about that but on the flip side I get chest infections quite regularly from colds and have been on steroids in the past and was off for a month in December with a chest infection and Breathlessness (though my new GP wouldn’t prescribe steroids because it’s a short term solution??). So I am scared about what it would mean if I caught it.

Does anyone know if that medication combination means I should shield?

Thank you

[CRP386]

Hi,

I saved down the guidance last week from the Asthma UK website on shielding. At that point in time it was as per below between the stars. The high daily doses of steroid listed included Relvar (184 mcg or higher per day). Although a lot of letters have gone out to people many have been missed and it is possible for your GP or hospital clinician to add you to the shielding list.

In the meantime, can you speak with your occupational health department about the risks given your chest history and medications that you take?

Normally, steroids are a short term solution (e.g. 5 day course) to help relieve symptoms of an asthma exacerbation during a chest infection.

****If you or your child is taking any of the below medicines:

You may not have received a letter advising you to shield yet, but we would advise you

shield anyway.

This advice has been agreed in collaboration with the National Clinical Director for

Respiratory at NHS England.

Any biologic therapy, also called a mAb (Xolair/omalizumab, Nucala/mepolizumab,

Cinqaero/reslizumab, Fasenra/benralizumab)

Antibiotic tablets or liquid for asthma every week as a preventer (e.g. azithromycin)

A combination inhaler that also contains a long-acting bronchodilator (e.g.

Seretide, Fostair, Symbicort) at a high daily steroid dose (see the table below)

An inhaler with a high daily steroid dose (see the table below) AND you are taking

Montelukast

******

[Londonliving in reply to CRP386]

Thank you for your reply, much appreciated.

I had spoken to HR briefly based on the advice that you referenced and that doctor did recommend that i shield.

My confusion is now the advice has changed again and I’m unsure what that means...

And sorry I don’t think I explained myself very well with regard to the steroids, I meant that I was surprised he wouldn’t prescribe them considering I was having an acute episode of my asthma. I have previously had them with chest infections and the Locum GP I spoke to recently gave me an ‘in case’ supply.

[CRP386 in reply to Londonliving]

Yes, I followed up with Asthma UK because I had some queries last week about the list. They state they have now removed the detailed guidance because most people should have received their letters. In reality, this is not helpful as many of us still do not have our letters. This was highlighted in a BBC article this week.

[CRP386 in reply to CRP386]

Yes, I am surprised too that the GP did not prescribe the steroids for an acute exacerbation!

[Hidden in reply to CRP386]

Hi, listening on a health programme Radio 4 yesterday, the confusion with Asthma and shielding was spoken about.

The radio GP mentioned charity groups listing previously and in response NICE had listed a Covid19 guideline as what is regarded as severe Asthma re vulnerability to Covid19.

There is a report with a table guide attached.

Severe being the requirement for Shielding

It will list the high dose required + the required second controller to prevent the condition becoming uncontrolled or if it remains uncontrolled.

Hope that helps

[CRP386 in reply to Hidden]

Thanks do you the have the link to the NICE guidance? Where is the table you describe so that we can view this information? Thanks.

[Londonliving in reply to Hidden]

This is helpful thank you very much.

[GYPSYMITCH]

Hi, in the asthma UK Covid 19 advice list for medications both Relvar and Montelucast in the combination you mention is on the list.. I’m on the lower dose of Relvar 92/22 and Montelucast which wasn’t on the list so I’m still being super careful. Luckily I live in the country so I’m still able to take the dogs for a good walk without meeting many people at all.. good luck and would suggest you contact your asthma nurse for further advice if you can. Stay safe x x

[Londonliving in reply to GYPSYMITCH]

Thank you, stay safe and glad you are able to get out without feeling like you are being put at undue risk. I have spoken with the practice nurse but she wasn’t especially helpful tbh. I think the advice is changing so quickly they are struggling to keep up.

[Poobah]

Sounds like you should be shielding given your meds and occasional oral steroids. And you mentioned a new GP. I'm wondering if you didn't get your shielding letter because you've moved and GP hasn't considered you for Group 4 (sweep up group identified by GPs).

If you can work from home then that's great. I know that you feel guilty because of the pressure on the front line but please don't. Guilt is not the best motivator and we tend to make poor decisions when we feel emotional. Please stay safe and look after yourself. You have many years ahead to serve in critical care. Right now shielding takes precedence.

All the best.

[Londonliving in reply to Poobah]

Thank you for this. I appreciate you taking the time to respond and being so kind. Means a lot and thank you for reassuring me.

[Hidden]

nice.org.uk/guidance/ng166/...

look for point 1.2