Struggling with symbicort, any recommendations

[CharlieLondon]

Hi everyone, HNY to you all, I’m new to this site and glad to be able to connect with others for support. In the last month or so my asthma symptoms have got so much worse. I have a cough like never before and so much mucus but tests show no infection. I pulled a chest muscle on New Year’s Eve due to coughing and now resting in bed as can’t move much. I am starting to think that this significant decline in my asthma might be due to change in medication. I was on clenil but changed to symbicort 8 weeks ago. They upped me to 2 puff twice a day as no improvement. I have constant wheeze and tight chest feeling. Anyone else had difficulty with symbicort?

[EmmaF91 Community Ambassador]

Hi Charlie

Welcome to the forum and sorry to hear you’re not doing well.

Have you had a short course of prednisolone? It sounds like you’re in an acute flare rn and may need more than just a change in preventer meds.

If you feel like the symbicort isn’t working, tell your GP and ask to switch to something different. What works for one, won’t necessarily work for another, and some people do better on mdi (puff/spray inhalers) compared to DPIs (suck/powder inhalers).

Do you have an asthma plan? If not and your peak flow is below 50%, you are unable to walk/talk/eat/sleep normally then you should be heading to a&e for more help - esp if you’ve already tested covid neg! Remember 10 puffs of ventolin is the equivalent of a neb; if you need 10 to calm the issue you need a GP appt ASAP, if 10 doesn’t clear the issue you need hospital.

For more about inhalers; healthunlocked.com/asthmauk...

Hope this helps and that you feel better soon

[CharlieLondon in reply to EmmaF91]

Thank you Emma, they gave me a short course of steroids a few weeks after starting symbicort as I was getting worse which really helped for about 2 weeks then symptoms came back and cough got progressively worse. I was taking my ventilin about 6 puffs 3 times per day over Xmas and then took myself to A & E on Boxing Day. They did lots of tests and all normal. Only thing they didn’t test was my peak flow. I am fairly new to monitoring peak flow but feel it is quite low ranging from 240 to 260. This went lower to 180 a few days ago. Can’t take it at the moment due to pulled muscle. Anyway I will get a medication review/ request changing back to clenil and take it from there. Thanks again.

[Poobah]

I'm wondering why your inhaler was changed from Clenil if your asthma was controlled? As Emma says, tell your GP ASAP about your poor asthma control and your thoughts that it could be linked to Symbicort. Not everyone can tolerate long acting bronchodilators, as found in combination inhalers such as Symbicort. In order to get out off this asthma hole you may very well need a course of oral steroids while you also change inhalers.

Any new medication should be reviewed after 6 weeks in order to ensure its effectiveness and any side effects. Never assume because a med is designed to treat asthma that it will help your asthma, its a very individualistic illness and requires treatment of the individual.

Hope you feel better very soon.

[CharlieLondon in reply to Poobah]

Thanks for your advice. I requested a change in meds as noticed my asthma symptoms getting worse. Gradually worsened over lockdown from March and had mucus build up too so they gave me amoxicillin for suspected infection and change to symbicort but after a few weeks symptoms, cough wheeze got even worse so they put me on steroids along with other antibiotics as no change in mucus. I have also had polyps in the last few years which thankfully shrunk with antibiotics and steroid spray. They upped my symbicort to two puff twice a day a week or so ago. I will ask for a meds review and change of meds if things don’t get better soon. Thanks again

[Poobah in reply to CharlieLondon]

Are you on dry powder inhalers? Having polyps is an indication that you may (not conclusive) have a sensitivity to aspirin. Any sensitivity may be on a range from mild to strong, so a patient may also have a sensitivity to aerosol inhaler propellants, and in some cases a patient will require dry powder inhalers in order to avoid the aerosol type meds.If this is the case then another possible sensitivity to consider is to sulphites. Sulphites are typically found in wines, ciders and beers as well as some processed foods. I'm not a drinker but could never understand why I got a sore throat then chest infection at Christmas/New Year - one toast of sparkling wine would be enough to make me ill.

These sensitivities aren't always prominent in childhood and can develop in adulthood. Just something to consider and discount when one's asthma changes for inexplicable reasons.

Hope you find the right meds soon. All the best.

[Hidden]

I had symbicort some years ago but developed what I think is called a paradoxical reaction to it, meaning it made my asthma worse; considerably so. Eventually just taking a puff made me wheeze so I reverted to my previous separate inhalers. I use fostair now without a problem.

[CharlieLondon in reply to Hidden]

Thanks. Can you remember how you came off it. Did you just revert back to the old medication or wean yourself off?

[Hidden in reply to CharlieLondon]

I just stopped as it was clearly making me worse, and reverted to the separate ventolin and beclometasone inhalers I had before. I think it was then a couple of years later when I had an exacerbation of asthma symptoms that I was changed to fostair.

[CharlieLondon in reply to Hidden]

Thanks. I’ve spoken to the Gp and have stopped. Will be starting back on clenil tonight. Fingers crossed things improve. If not I will ask to try fostair.

[BlueBlobs1]

I just looked up the one you were on, generic of qvar and it's the same steroid as fostair so a fine partical steroid. The finer particles can get deeper in the lungs and many people find its better for stopping mucus. Perhaps fostair could be a good option as it adds the long acting bronchodilator to the steroid as the symbicort does. I find a salt nebuliser and a mucus expectorant useful for shifting mucus, combined with a huffing cough after. The rescue inhaler can aid in breaking it up as well. Try not to let the mucus get bad, try to keep it moving as you don't want it to block your airways. Keep your fluids up.

[CharlieLondon in reply to BlueBlobs1]

Interesting. I’ll look into salt nebs. Never heard of huff coughing before but will goggle. I’m going to start on clenil again but if doesn’t work I’ll ask to try fostair. When you talk about the rescue inhaler are you referring to ventolin or something else?

[BlueBlobs1 in reply to CharlieLondon]

Yep ventolin, some people like to take the ventolin before using the salt nebuliser, incase the salt irritates and triggers you ( doesn't me ) and also because it opens things up and aids in breaking down the mucus. The isotonic salt that you can get OTC people say is less irritating then the strong prescription only hypertonic ones.

[Sudhirdhir7]

I have been on symbicort also for nearly 4 years.what has really made the difference is spiriva inhaler taken once a day with it. Each individual is different but this seems to work for me. However sometimes you have to explain things to your doctor fully!! It’s your health.