Fostair alternatives

[B_Asthma]

I am new here. I suffer with severe asthma and I am on the UK government's list of 1.5 million vulnerable people for severe corona virus complications due to my severe asthma.

I take fostair 200 / 6 2 puffs x 2 day, with Spiriva 2.5 mcg, singlular, and Ventolin. This spring my asthma has not been well controlled and I have just completed a course of prednisone with no relief. I have been fostair for 3 years and find if I don't have a flare-up Fostair is fine but with a flare-up it does not seem to help control my symptoms.

I have advocated to my GP that my Fostair dosage should fit the time of season (higher dose when I am prone to flare-up and lowering the does when I am less prone). Typically, I am prone in spring and then late fall / early winter right before the first frost.

So, I am wondering if asking for something stronger than Fostair will be a better idea.

[KnPoa]

I’ve had the same problem, I am on fostair 200/6 2x2, montelukast, fexofenadine, ventolin. My asthma is poorly controlled, I can go a good couple of months then hit a few bad months (normally spring and winters). My doctor is really good about asthma but he insists that Fostair is a really good inhaler and won’t change it. I spoke to a locum doctor a couple of weeks ago when I had problems and she said when I’m having problems to up my Fostair to 2 puffs 3 times a day, if that doesn’t help try 4 times a day (when I rang 111 a few months ago after a flare up, the lady on the phone said I can take Fostair upto 8 times a day!) and to up my fexofenadine to twice a day as it’s allergy season.

Have you asked about taking a antihistamine? It could be allergies around that time? Might help.

If you need advice ring the asthma nurses on asthma Uk, they are really good, they can advice you on what to do.

But do speak to your GP again, or get a second opinion from another GP in your practice.

[B_Asthma in reply to KnPoa]

Thanks for your nice reply.

I have a steroid nasal inahler and I take allergy medication too.

Like yourself, I am told the same thing that Fostair is great and it can go up even further. I have had several increases of Fostair but when it is increased, it provides some albeit marginal relief. So, I tend to ask for prednisone over Fostair when I have a flare-up, because prednisone will give me more comprehensive relief than Fostair. However, with this flare-up prednisone has not given me the relief I normally get with it and given my history with fostair, I am reluctant to ask for a further increase in dosing.

[KnPoa in reply to B_Asthma]

I try and swap my antihistamines every couple of years as I feel the longer I take them, the more immune I become to it.

I would personally ring 111, when I have spoken to them, they have been really good and given advice. I rang them a day after going to the doctors (I saw a locum) who said nothing was wrong, 111 sent me to the emergency doctor, Who said in fact I had a chest infection and my whole chest sounded like sandpaper and wasn’t sure how the locum had missed it. 111 can sort the current problem.

Definitely get back in touch with your GP and discuss your concerns. Maybe take you peak flow for the next few days/week and show if it’s dropping.

I would ask to be referred to the specialist if the GP still won’t change the inhaler.

[B_Asthma in reply to KnPoa]

I will try that, thank you.

[EmmaF91 Community Ambassador in reply to KnPoa]

Hi

Just to let you know the maximum dose for Fostair 200/6 is 4 puffs a day. More will not make any difference as you are at the steroid dose that’s been shown to make the most difference (like if it like you’re basically at full absorption at 4 puffs) so an increase will not make any noticeable difference to you (fostair 100 can have 8 puffs so that may be the confusion with 111... the mart regime is only used with fostair 100). It may be worth asking for a 2nd steroid preventer inhaler to ‘top up’ the fostair, but you need to make sure it’s a different steroid base. It’s also worth asking for a referral to your local consultant/a spec hosp (depending which you’re under rn) as they have more options available to them (such as azithromycin, theophylline/aminophylline, MABs etc etc), and some people do better on braltus compared to spiriva.

I use relvar as my reliever (suggested by Brompton) and seem to do better on that than fostair. However relievers are personal. Not sure which antihistamines you’re on, but nasal spray wise dymista has an antihistamine in it, and avamys is the best steroid spray I’ve found.

Hope this helps

[B_Asthma in reply to EmmaF91]

Hi Emma,

Thanks for the reply.

If I remember correctly, my pulmonologist has said, there is more latitude with Fostair up to 2 puffs 4 times a day but my GP has said I am at the max for Fostair.

Relvar is definately something I will ask about.

[EmmaF91 Community Ambassador in reply to B_Asthma]

If you have fostair 100 you can have 2x4 a day. If you’re on 200 you can have 2x2 (basically the max is 800). Your body just won’t absorb any more of the steroid than that. So no major improvements but you’ll get worse side effects from the other components. A 2nd inhaler with a different steroid base would be better than having too much fostair because you’re body will absorb the other steroid, but won’t absorb the increase. I hope that helps explain it.

[B_Asthma in reply to EmmaF91]

Hi Emma.

Thanks for another thoughtful reply.

I take the 200 / 6 and my GP has told me very little of the steroids in Fostair is absorded into the body and for the most part, it stays in the lungs. Hence, the reason why they prefer to increase the steroid inhaler over giving steroids like Prednisone.

As for me, I have never found Fostair to be 100% effective. It is good if the allergy season is mild but not effective during peak allergy season.

[Melanie1989 in reply to EmmaF91]

Thats really interesting Emma, as my g.p and consultant have had me on fostair 200/6 3 puffs twice a day for 6 months! No wonder it hasn't made a difference! Thanks for the info!

[EmmaF91 Community Ambassador in reply to Melanie1989]

Welcome. I discovered it cause years ago I was told to MART on my fostair 200 by my hosp con (when I was on 2x2 anyway). Big surprise when it made no difference and I used blue as I always had. Few months down the road I talked to someone different at the hosp who were like ‘why have you been told to do this? It’ll be pointless cause xyz’. Not sure if it was a con or an AN, but yeah 800 is the max most will absorb and so more will make little (if your body will take 900) to no difference... people forget the dose difference in the 100 compared to 200 so people 200 get told up to 8 🙄🤦‍♀️. Similarly apparently MART should only be done with the MDI not a DPI (another thing My hosp then did wrong...)

I do hope you get somewhere soon Melanie cause I know waiting lists aren’t going anywhere atm 😞. Stay safe

[Blue-Breeze in reply to EmmaF91]

Hi Emma I'm on 100. I was told by my CNS I could take up to 12 in a day. I did query this as I said I thought it was only only 8. Will ask again at clinic

[Poobah]

I was on Symbicourt but it did nothing for me. The more I took, the more I seemed to wheeze. Asthma nurse changed me to Fostair (much lower dose) & it's been good. She said particles were smaller so get right into the lower tract.

I was also on Spiriva and it was great for a couple of months then my asthma just deteriorated to the point where I felt really ill. I'm now on Eklira Genuair and it's great. No decline in effect.

Just wondering if it's not Fostair that you need to change but Spiriva.

What I have learned over the years, is that it's all trial and error. What one person does well on can make things worse for someone else. My pal has been very well on Symbicourt, not me. We're all different and only you know how you feel. Definitely go back to the doctor and ask to try an alternative.

All the best.

[B_Asthma in reply to Poobah]

Hi Poobah,

Thanks for that great reply.

I agree, it is a bit trial and error. I have been on Fostair for a few years now and I have a good understanding how it helps me.

I have a bit of chest wall inflamtion too, which sprivira helps to reduce and before I was on spririva I went through a 12 week episode where I was in my GP about every 2 weeks trying to get some relief.

If my Spiriva inhaler is running low, I can always tell by how I struggle to inhale. So, I am a bit reluctant to try changing Spiriva since it is the only thing keeping things controlled.

Before I consider changing Spiriva I would like to see if I get any relief from making changes to Fostair. Symbicourt does seem like something I will ask about because I use my Ventolin way too much and I have been asking for something stronger to allow me to minimise my Ventolin use.

[Poobah in reply to B_Asthma]

Symbicourt is very much like Fostair, they are both combined inhalers. But definitely try Symbicourt and you'll know very soon if it's any good for you.

If that doesn't work you could ask for an additional steroid inhaler but depends on the maximum dose of inhaled steroids your doctor is happy with.

Eklira Genuair is a LAMA inhaler, same group as Spiriva. If you're happy on Spiriva best not tinker with that. I can tell the difference if I'm late in taking it.

I recently had a course of oral steroids (first in ages) & it's a shame we can't achieve the same measure of relief with other meds! Apart from some side effects, I always feel like superwoman when on prednisone. Oh well!

Good luck with Symbicourt.

[Pipsqueak77]

Hi B_Asthma

You can get prescribed a higher dose of steroid/combi inhaler but it would be ‘off label’ meaning not a licensed dose and would therefore have to be recommended by your consultant/hospital team.

So they would look at your individual circumstances and make a judgement as to whether you might benefit or not.

I would chase your hospital team for advice..😊

Take care

👍

[Abc64]

I take the same fostair dose, braltus, Ventolin , carbocistine and a montelukast tablet at night. I also take loratidine, which is an antihistamine , every day. I do have bad days, but, on the whole, this combination works. The carbocistine is to help with the mucous.

When I was on the lower dose of fostair, I had 4 puff twice a day, but now I’m taking the 200/6, it’s 2 puffs twice a day.

[B_Asthma]

Update: Thanks to all of you that have repled. Many Thanks,

Yesterday, I spoke with GP who has given me another course of predinisone and I asked to have Fostair changed. My GP is going to have the asthma nurse call me to do another asthma review, probably today.

Advised the GP the last asthma review I had was a total waste of time because the astma nurse became fixated the issue was acid reflux even though I my asthma was being exhaserbated because it was peak season for me, my history does not indicate acid reflux has ever been an issue, and I have underlying heart issues. I told the GP I did not feel as though I was being listened to and I did not feel the asthma nurse was considering my history. So, I advised the GP I am not going to waste my time speaking to an asthma nurse that does not listen and does not consider my history.

So, when I speak to the asthma nurse today I will again reiterate I want to change my Fostair because I don't believe it is as effective a choice as others could be.

[B_Asthma]

Further update: I have spoken with my asthma nurse. This time it was not bad. I asked for another steroid inhaler besides Fostair and I will be prescribed Revlar. I am told this has to do more with what a GP can prescribe versus a Hospital Consultant. Since the GP is prescribing it then medications like Flovent and Qvar will need to be prescribed by Hospital Consultant. The nurse stated I am still under the care of the chest clinic for asthma at my local hospital and suggested I make contact to get an evaluation to see if Revlar is right or there is something more suited due to the prescribing limitations for GPs.