Hi my asthma is flaring up again been on several courses of prednisone since January, had a long course which has given me a couple of months when I have been okay but it is now flaring up again in that I am using rescue inhaler 4-6 times a day on top of 2 in am 2 in pm of Fostair 200/6 and Montelukast pm and Fexofenadine for hayfever so Dr prescribed prednisone and to switch to MART using my Fostair 200/6 as rescue and preventer. Just looked and it says max of 4 puffs daily. Rang Dr and receptionist said speak to pharmacist, rang pharmacist and he said beyond his understanding and Dr should know what she has prescribed so to go with it. Checked on web and it says no more than 4 puffs - don't know what to do should I ignore the max of puffs a day? Waiting for Thoracic referral but been on hold due to COVID since March so am not expecting it anytime soon.
Sorry for the moan everyone, thought I was finally trying something that could help and now worried in case I am taking the wrong dose. Just hoping that someone will understand. Thanks
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Hiltay
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When I was in hospital...although it was the consultant that prescribed it...I had 8 puffs of Fostair 200/6...on a regular basis, although it’s an unlicensed dose I think. I had that along with a billion other inhalers too. But, I’m not sure in regards to your MART regime.
I’m sure one of the others will have some useful advice. It makes me cross when doctors/AN don’t explain things properly to us! Maybe you could give 111 a call for advice? Useless receptionist by the sounds of it!
Thank you for your reply, I think reading other posts the Dr wants to try and hit it hard so will go with it and try and ring again after the weekend, just too exhausted to battle a receptionist today 🙄🙄
Hi Hilary. I take Fostair 200/6 and was recently told by the nurse in respiratory clinic that I could take an extra two doses. My peak flow was on the slide (usual for me in September) so the idea was to avoid having to take prednisone. I did that for a week and my peak flows started to creep up.
My understanding is that it is not exactly like a MART regime as you cannot use it as a rescue inhaler in the normal sense, because it does not work quickly enough. You would still need your blue for this.
Strictly you should have a written MART plan so that you know what the maximum dosage your doctor has designated you. The plan would also say what action to take if the maximum dose of Fostair pd doesn't address your asthma flare up.
I've been encouraged to use the MART system previously but it just didn't prove successful and I ended up taking increasing amounts of the combo inhaler daily while my asthma just went downhill. The consultant was most displeased as they had assured me that I didn't require any Ventolin - I went 6 months and it was awful. Subsequently, I read that dry powder combo inhalers may not be sufficient for some patients and a reliever inhaler helps in these cases.
I'm now on Fostair 200/6 & it's much better than my previous combo, but I also need Ventolin.
You may need to try different combo inhalers in order to find the one for you, but if you're not happy with MART, say so. It doesn't work for everyone, for whatever reason. We're all individuals and one size treatment doesn't fit all.
Unfortunately my Dr surgery doesn't have anyone who will look at medication changes I have been trying to get something done since last October when the flare up started but this time the MART was suggested as they knew I was waiting for a referral to the hospital which in the present will take a while
That's so frustrating! We do have a very good asthma nurse in our practice but also an community respiratory team that is like a half way service between the GP level and the hospital level. They are excellent.
I understand though, if you are currently under the care of the hospital respiratory team then your GP will be loathe to change your meds, however, either you or your GP can phone them to arrange for a change or supplementary meds with their blessing.
That's a puzzle. Usually the GP will try different meds if a patient isn't under a consultant. There are a range of combination inhaler options available. My asthma nurse changed my combo inhaler from Symbicort to Fostair and it worked very well for me. So it is possible to try other meds in the same field without specialist intervention.
It may be worth speaking to an Asthma UK Nurse about how to proceed. tel:+44-300-222-5800
I've been taking 8 puffs of fostair 200/6 during a flare on my gps advice whilst waiting for a referral. My consultant said its not a long term option as there are more effective treatments for uncontrolled asthma but if it helps settle things down within a month or so and then I can reduce back down then that's OK.
You should only use thee Fostair 100/6 as MART. You are right in saying that you are at present using the Fostair you have at the maximum daily dose....ie 800. You need to discuss this with your doctor again..ask to clarify the fostair dosage.
If an asthma professional prescribes Fostair 200/6 as MART, it definitely is fine to use it. My hospital consultant says that although not the norm...it is often used to treat those with severe asthma than has been difficult to control.
I questioned my hospital consultant who changed my Fostair 200/6 to the MART system at the end of July. She said is ‘off piste’ but, not uncommon when trying to get folk’s asthma under control. So I am using two puffs am and pm plus, up to another four puffs throughout the day as needed. She also asked me to continue using two puffs of Ventolin immediately prior the AM and PM Fostair 200/6 plus, two pulls of Spiriva immediately after the am Fostair and Montelukast at night. She then also threw Carbocisteine into the mix (to try and shift the deep seated mucus plugging at the bottom of the lungs - and Omeprazole to help with the acid reflux. Pleased to report that after being diagnosed in May 2019 (at the age of 73), things FINALLY seem to be easing up and I believe I can get my life (or what’s left of it) back on track. Do hope that it works for you....
Thank you I have just finished the tablets and am using the fostair as rescue and preventor willing to give anything a try and so grateful for everyone's experiences 🙂
Truly hope that it all goes will for you. It seems that there a numerous combinations GP’s and consultants will try to help....not all of them are necessarily traditionally accepted methods. However, be assured that they are trying ease your Asthma symptoms - and not trying to harm you.
Also, my consultant says that by using the Fostair 200/6 as MART, the regular use as a reliever as well as a preventer will build up the corticosteroids in the lungs, exactly where they are needed., rather than with Prednisone that will have to pass through every organ in the body before they get there. Fostair 200/6 used as MART will, overtime, hopefully will lead to less use of Prednisone. Seems a possibility.....
That's interesting. I have in the past used very high doses of inhaled beclametasone instead of oral steroids to get me over an attack (when I was using separate inhalers, beclametasone and salbutamol). The problem with the combination inhalers is that they have a long acting bronchodilator, rather than the short acting salbutamol, and this has effects on the blood pressure and the heart rhythm. I know that when I've taken an extra puff of Fostair 200/6 in error I tend to get ectopic beats.
However as you say if your specialist recommends it I guess you should go with it. Anything is better than not being able to breathe.
As mentioned earlier stones93, my consultant also has me taking two puffs of Ventolin immediately prior to my two puffs of Fostair 200/6 each am & pm - as well as up to four extra puffs of Fostair 200/6 throughout the the day and I can precede each if those with Ventolin if things really are very bad - at which stage I should consider going to A&E or calling an ambulance. You are correct re; affects on the blood pressure (that I also have) and the heart rhythm. I have had a 72 hour monitor to check my heart - which was absolutely fine - but the symptoms were attributed to my body adjusting to the higher level of medications. Apparently, for a 74 year old with bilateral hip replacements, my heart is in extremely good fettle....just the lungs that have become absolute rubbish....,😊
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