I’m in the sixth week of oral prednisolone for asthma - tapering down 5mg a week from 40mg starting dose. Annoyingly, when I got down to 20mg, my peak flow started to drop so the doctor told me to go back up to 25mg and also to double the Fostair to 8 puffs a day. Is that a normal dose - I thought 4 puffs was the maximum?
I’m really struggling with all this - I’m taking Fostair, montelukast, uniphyllin, Spiriva Respimat and the steroids and the side effects are horrible- tremors, nausea, indigestion and heartburn, awful insomnia and fatigue, bruising. I hate feeling like such a moaner (forgot to mention the oral thrush!) but I don’t seem to be making much progress at the moment.
I’m shielding and furloughed and my colleagues (with the best of intentions) keep telling me how well I look (the steroids make my cheeks pink) and how lucky I am to be ‘sitting at home doing nothing ‘!
Well, that was a monumental moan - sorry folks!
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TeachKat
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Sorry to hear you are so unwell, it must be awful. I am on only a 5 day course of steroids which is causing insomnia and not pleasant so I can only imagine how awful it must be for you.
Maybe you should mention to your colleagues next time how you would give anything to feel fit and well and be at work, then feel like this and be stuck at home. You need empathy and support and by letting them know how you are feeling may change their approach with you- making you feel better.
I imagine you’re feeling weak and sensitive and colleagues comments don’t help- I have had experience of this myself!
Thank you for your kind reply! I’m very grateful to be able to stay safe at home but every so often it does get me down. If I could only get some sleep, I’m sure I’d feel better. I hope you feel better soon too!
I've never heard of 8 puffs, seems a lot. I've been there with the steriods, it's a lot harder than people think, mentally it's draining. Hope you get well soon. All the best TeachKat.
Hi TeachKat. That does seem a lot of inhaler. I also take the fostair 200/6, currently 2 puffs am and pm. I'd be questioning staying on such a high dose for very long... Something to bring up when you're feeling better.I hope you have someone looking after you sounds like you need it. Those pred pills are horrible and always make be feel emotional so take it easy and moan if you think it'll make you feel better 😊
I can't advise on the Fostair, but just to say I totally empathise with the horrible side effects of prednisone, even without the sheilding/ furlough. Hope you're able to reduce below 20 this time 😊
My consultant increased my Fostair dose to 8 per day about a year ago now to help me avoid using ventolin too often and it has helped but when I’m having better days/weeks I reduce to 6 per day.
Just like you I take Spiriva and Montelukast but I’ve been stuck on maintenance prednisolone for 2years now. Currently weaning at 1mg/2mg from 20mg as I can no longer drop by 5mg anymore..the side effects all of these drugs put together are just🥴and it’s horrible sometimes knowing your taking so many meds..but hopefully you will start to see some improvement soon🤞
It’s nice to know that I’m not the only one on that dose - they usually tell me to use daktarin gel for the thrush - it helps but not long term. I wonder if I would do better dropping in smaller steps- thank you. I hope you manage to get off the prednisone!
Hello, my consultant put me on 8 puffs Fostair 200/6 when I was in hospital...in fact was on very similar meds to you...Fostair 8 puffs
Spireva 2puffs
Alvesco 160 4 puffs (I think)
Phylocontin
Montelukast
Avermys nasal spray
Certitizine
40 mg pred
This was during a hospital admission for an 11 day severe attack that was hard to gain control over, but I was on all that for quite a few months afters and gradually got stepped down.
I think it’s just an unlicensed dose. Sounds like you’re really struggling!!!
Hi! Yep - it’s not so brilliant at the moment ☹️. The only plus is that the steroids have really reduced the arthritis pain and swelling in my hands, at least temporarily! And I have finally had a blood test for the uniphyllin levels - results due on Monday. I’ve only ever had short courses of steroids before this so I’ve not really felt the emotional effects like this - yuk!I hope you’re doing ok xx
Bless you! Yes, keep an eye on your mental health with long term steroids...they affect me really severely, and like I told you, I can’t take them long term anymore (it’s even written on my notes not to prescribe them long term)
It’s amazing how people can look at you and think you’re doing so well isn’t it, when you’re feeling at your worst.
Every cloud had a silver lining...reduced pain and swelling in your hands! 😘
I was on Fostair 200/6 and I was told I could go up to 8 puffs a day. Instead of having my Fostair increased, I asked for another inhaler and I was put on Relvar, which is working wonders.
Oh Teachcat, I'm so sorry - what a horrible flare up. I absolutely hate pred and the way it makes me feel. I just don't get on with taking one big dose a day and fare much better on breaking it up over the day and then taering it - all contrary to current medical thinking. Not that I'm suggesting that for you.I take VitD3, VitK, potassium, magnesium and fish oil at bedtime for my bone health (thanks to steroids) and that helps me battle insomnia - drowsiness is a side effect for me. I still wake up after about 4 or 5 hours, but better than nothing.
Family, friends and colleagues can struggle to understand how asthma and the meds affects us and that can be exasperating at times. I must admit that the current pandemic has helped as they now realise that "clinically extremely vulnerable" has given it a more dramatic grouping as a disease.
8 doses of Fostair 200/6 is not a maintenance dose (which is up to 4 daily doses). But given your current symptoms your doctor may think that this higher dose will help you get control in order to be in a position to reduce your pred.
I was on Spiriva but after about 3 or 4 months it lost its effectiveness. I swapped to Eklira Genuair and it really suits me - but that's just me. Just like LABA inhalers, there are other LAMA inhalers to try. It's an option.
As someone else has suggested, a much more gradual reduction in pred over a greater period of time may be more manageable and less of a shock.
As for moaning - you're entitled. A daily rant is necessary. Then watch your favourite comedy. But don't laugh too much. 🤫 Comedy is my outlet.
Thank you, Poobah - I’ve just started taking potassium and magnesium - I’m wary of taking too much so I got a two tablets a day kind and am just taking one a day of each. The potassium does seem to reduce the shaking a bit. I’m toying with the idea of taking the prednisolone at about 4:00 am (when I’m always awake) to see if I can get a bit more sleep earlier in the night! Reading is my escape- but it has to be light -hearted at the moment- I can’t handle even the smallest amount of fictional tragedy just now! Bring on the Georgette Heyer😃
Hi! I take 8-10 puffs a day of fostair for severe asthma. Plus another steroid inhaler on top in the hay fever season. For the first year that I went up to that dose, I definitely got the shakes from fostair but I think I’ve grown used to it and doesn’t happen as often.
Please don’t feel like a moaner. It’s completely understandable to feel the way you do when the treatments that keep you alive also seem to make you ill. Trust me I understand.
For the oral thrush (recently started being prone to it myself) I’ve started rinsing out with an alcohol free mouthwash after my inhalers rather than just water and it seems to be helping.
Hi TeachKat, From the USA here. Sometimes it seems there is no substitute for the pred to open up those lungs. After being on them for 5 months (moon faced and shaky) my Doc put me on Colonzapam (a drug used for panic attacks, and seizures etc). Presto, I not only stopped shaking and felt relaxed, but I was able to gradually get off the pred and now completely off and asthma is treated with Albuterol inhaler and nebulizer. I feel like a new person! I’m only sharing because I want you and others like us to feel better!!! So sometimes if your nurse or Dic can give you something to relax you a bit and may help your asthma. Hope you feel better soon!
You poor thing. That sounds really awful. When I was having problems reducing oral steroids rather than increasing my 4 puffs fostair 200 my consultant started me on ciclesonide inhaler which is a less systemically absorbed inhaled steroid ( converted to active steroid in the lungs) but without the formoterol, as he was concerned that more than 4 doses of that was too much. This has worked really well- 4 puffs of ciclesonide and 4 of fostair 200/6 a day. Oral thrush still a problem but it seems a really good inhaled steroid to add in. I wonder if that might work for you? Just a thought. I hope you are feeling a lot better soon- those oral steroid side effects are so horrible. And you were not moaning- you are having a rough time 😔
Feeling for you. I’m not on fostair but on Flutiform highest dose and when in an exacerbation my doctor does advise to increase to 8 puffs which is higher than indicated. It is a bad place to be when on increased steroid inhaler and oral steroids. Additionally so when peak flow not moving and still suffering range of symptoms. Don’t worry what others may be thinking. You need to make sure you get the rest you need and that you are fully recovered before getting back to work and normal routine. Often I find that I am seemingly feeling ok, because all I’ve been able to manage is being on the sofa, but soon as try to get back to normal i struggle. If you still feel that asthma symptoms not improving, the length of time you’ve had symptoms is very long, go back to doctors. Hope you feel better soon.
I have previously been told I can take my Fostair inhaler 2puffs 4 times a day when I am bad or have a chest infection etc to try and stabilise. Originally by a and e doctors then by a couple of GPs.
If it’s any help, as someone taking Fostair 200/6, I questioned my consultant when she put me on the MART system....all inhalations immediately preceded by Ventolin. She said that it is off piste and unlicensed but, often used when trying to get a patient’s asthma under control. I also take Spiriva, Montelukast, Mometasone Furoate, Carbocisteine, Omeprazole and Prednisone as needed. So, long reply short - Fostair 200/6 used up to 8 times a day is okay - if a GO/Consultant has authorised it...😊. Truly hope that you feel better very, very soon..x
Interesting! I have just had a new AAA, and on it it says if I need any more I should take an extra puff of Fostair, no mention anywhere of salbutamol at all. Like you I am already on 4 puffs daily. I suspect they didn’t properly check what they said, and I will bring it up in my phone review on Monday. It just feels wrong, unless specifically prescribed, which as far as I know it isn’t.
This is the mart regime - but should only be used on Fostair 100/6 not on the 200/6. As far as I know! Might be worth calling Asthma UK to check before you query it (if it helps to have some "weight" to it although if they normally listen to you then you might not need that).
Yes, I was put on MART but no one had told me. I used to be on SMART, which I liked, but then Symbicort was changed to Fostair, shortly before our first lockdown. Things have moved on. I did ring Asthma U.K., but couldn’t easily get through, so instead I rang my dispensing pharmacist, and she confirmed the max 4 per day. And then I got a review for Monday.
I was/am having a slight flare, probably due to us just having redecorated our hall (much needed), so it became an acute issue. (I also have a history of denial of taking things seriously enough, so I am trying hard to be more grown up about it.) For now I decided to use my Ventolin instead, until I have had a chance to discuss this. And luckily, it has not been taken off my repeat prescription list. And my PF doesn’t seem to be dropping any further.
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