Inhaler dose

[Lee2k182]

I was just curious on how dose works with steroid inhalers.

I'm currently new to the asthma world and and I'm aware that asthma is a lot about trial and error when it comes to treatment especially in early diagnosis. I'm currently using symbicort 100/6 2x am, 2x pm and been on it close to 6 month. Although it's taken away my wheeze, I personally don't think it's doing enough as I still have a very mild cough (more soreness around lower throat near sternum), some chest congestion with a very small amount of clear phlegm production, mainly on a morning.

I will talk to my resp consultant about these when she gets round to rescheduling my appt that was due this week, but back to my question- if it's decided that I need to increase my dose, is taking more of the 100/6 (i.e doubling to 8 puffs a day instead of the 4) the same, as say, symbicort 200/6 2x am, 2x pm. Or is the 200 version completely different?

Hope that made sense

Thanks

Lee

[twinkly29]

In that example, no it wouldn't be the same.

100/6 is 100 of the steroid (budesonide) and 6 of the LABA (long-acting bronchodilator, formoterol in this case).

200/6 is 200 of budesonide (so yes double the 100) but still 6 of the LABA.

So doubling the 100/6 would also double the LABA element.

I don't know how they decide which bits need increasing though!

[Lee2k182 in reply to twinkly29]

Thanks for explaining that. Maybe I should have used the brown inhaler as an example as I was curious about the steroid part only.

So if I was taking 4x puffs of the brown inhaler a day and doubled it to 8, that would be the same as the stronger version of the brown inhaler at 4 puffs a day?

I just didn't know if the stronger steroids work differently than the weaker ones or if it was as simple as just giving you more at less puffs.

[EmmaF91 Community Ambassador in reply to Lee2k182]

If you’re just looking at the steroid component, it really is as simple as more steroids in less puffs 😅. Think of it like swapping 2 100mg tablets for 1 200mg tablet. It’s the same drug, the same dose, it’s just 1 less tablet.

When you switch brands of inhaler (say from fostair to symbicort) you switch steroid base, and you may find you have a better reaction to it, but there isn’t a ‘stronger’ steroid inhaler as in an individual drug (they adapt the dose so get the equivalent doses of steroid strength). To gain strength you increase quantity (there is a maximum limit you can take if each type of steroid because your body won’t benefit from any higher)

Hope this helps explain it a touch

[twinkly29 in reply to Lee2k182]

And presumably with the Clenil inhaler it will depend on the dosages of the steroid. I can't remember what they come in but if, for example it was 100 and then 250, obviously doubling the 100 wouldn't be the same.

[Lee2k182 in reply to twinkly29]

Emma, twinkly- thank you both for clearing that up. I assumed it was as simple as it being the same but in fewer puffs, but thought I'd get it confirmed. 🙂

[SJW011219]

Hi Lee,

Don’t know if this will help. Bit I was swapped from Symbicort 200/6 over to Fostair 200/6 which was 2 puffs AM and 2 puffs PM. After 6 weeks found it wasn’t helping with symptoms and was on the max dose per day. Asthma nurse swapped me to Fostair 100/6 which is 2 puffs AM/PM plus 4 additional puffs as and when I need them throughout the day. My asthma nurse said that with the 100/6 you basically get a higher dose of the steroid in the two puffs together because it’s be 200/12 where before it was 400/12. So, I should find more benefit from the 100/6. Even though I am still having issues the Fostair 100/6 has helped me a lot more. Not sure if that made any sense or helped! 🙈

Take care!

[Lee2k182 in reply to SJW011219]

Thank you, I keep hearing good things about Fostair, I just need my respiratory appointment to be rescheduled so I can request for a change.

I honestly think that symbicort has made my symptoms worse, I felt better with just my ventolin. Since symbicort, I have a congestion sensation in my chest, tremors in my hands and an irritated lower throat that kinda makes me wanna cough but doesn't.

Definatly gonna push for this fostair

[SJW011219 in reply to Lee2k182]

I found that Symbicort gave me little to no relief. And also I had a very dry throat a lot of the time with it! It did also give me terrible hand tremors and if I’d use it at work I felt like I had to explain because they could be so bad! I would definitely speak to them about Fostair because it has changed my symptoms for the better. I was on Symbicort for a long time 5+ years so I’m not sure if my body just didn’t like it or had got a little bit immune to it. I hope you sort yours out! Nothing worse than not having good control on asthma 😫

[Poobah]

I swapped from Symbicort 200/6 2x2 to Fostair 100/6 2x2. As the particles of Fostair are finer the effects are stronger, according to my asthma nurse & doctor. I've also read that. So 100mg of steroid in Symbicort has less potency than the extra fine steroid in Fostair 100/6.

This chart explains the strength of the extra fine steroid in Fostair, northeast.devonformularygui...

So 100mg basic is equivalent to 250mg in extra fine steroid.

That aside it may also be worth discussing with your asthma team about post nasal drip and acid reflux given that you experience the irritation in the lower throat and phlegm. Definitely two things to rule out as irritants.

All the best.

[Lee2k182 in reply to Poobah]

Thanks Poobah, do you notice improvements on Fostair compared to Symbicort? I think my resp cons put me on symbicort because i got thrush when I trialed Clenil (spelling?) So she thought powder would be better. But guess what? I have oral thrush again, on symbicort. I guess that's a side effect I'm just gonna have to get used to now and then. But to be honest, it's my fault as I have gotten lax on rinsing my mouth, especially when I work lates and nights and just take my does quickly at work.

[Poobah in reply to Lee2k182]

Yes, I noticed an improvement as did my family and friends. Less huffing and puffing when I walked.

Last year I was taking the max amount of Symbicort but just getting wheezier and felt like I had less and less capacity. My asthma nurse was the one who recommended I try Fostair and followed up with me after four weeks to see how I was getting on. I did have a nasty virus in February/March so that's affected me quite a bit so I'm now waiting to go onto Fostair 200/6.

[Hidden]

No. Don’t take more of the Symbicort than prescribed. It has two medications in it. That second medication should stay the same even though you might need more inhaled. I take something similar to Symbicort, Wixela. Since my asthma has been severe, it’s been upped to 500, but the second Med, a LABA, stays the same.

LABAS can be bad for asthma if not taken with an inhaled steroid—or if you take too much.

Let your consultant sort this out.

[Lee2k182 in reply to Hidden]

Thanks suckitup. I am currently on the SMART regime with symbicort. I was told to take 2x2 am/pm and up to 8 additional puffs a day if I'm symptomatic. I have only ever taken 2 extra puffs a day so far and honestly, I think it's making me worse so I'm just back to 2x2 and ventolin if needed.

I can never get a hold of my respiratory consultant and I don't wanna keep hounding her secretary, especially during the pandemic. There's more poorly people than me. So I'm just holding out for my appt to be rescheduled to talk to her.