Given lower dose of preventer

[Birch_]

Hi all, me again! I picked up a new inhaler today and used it this evening. After I used it I realised it is a lower dose than my old inhaler which has confused me because I was told I’d be getting a stronger one. I was on clenil 200 “puffer” 2 puffs, 2x a day; new inhaler is fostair 100/6 powder 1 dose, 2x a day. By my maths, that’s 25% of what I was on before and they are both beclometasone. Unless the powder is much more effective than the other inhaler, it doesn’t make sense to me at all and I’m not sure if I should keep taking my clenil until I can ring the GP and check if this I right or if this is normal and I should trust them. Is it even safe to have such a big reduction of dose? I know you shouldn’t stop completely and should taper so this does worry me.

Annoying that I only discovered this on a Friday night and can’t talk to anyone until Monday! Any advice would be really helpful, thanks 🌻

[twinkly29]

Yes definitely annoying with the timing!

Safety wise it's totally fine.

Dose wise, you're right of course.... the Fostair also has a LABA (long-acting bronchodilator) in it though so assume they're starting on that to see if that, with the steroid is a better combination for you than just the steroid. Side note: the LABA bit is the bit that can give people side effects (like increased heart rate) but these should subside over time.

I think I'd go with it over the weekend and check with your GP on Monday - but the additional laba element should compensate.

[Chip_y2kuk]

As twinkly29 said the fostair is the same steroid but also has the formoterol which is a much longer lasting version of salbutamol .... formoterol lasts up to 12 hours but salbutamol is up to 4 hours

So although it is a lower dose steroid your airways will be "opened " by the formoterol and in theory you shouldn't need quite as higher dose of steroid... however the wonderful thing about fostair and some of the other combination inhalers is that they can be used in MART... which might be worth speaking to your gp about

Effectively in MART (Maintenance and Reliever Therapy) you use your fostair/combination inhaler instead of ventolin/salbutamol up to a number of puffs (usually 8 but can be more) so every time you start to struggle you get a shot of LABA (the formoterol in fostair) and a steroid to help reduce/counter whatever irritation is causing the issue ..... unfortunately you will still need to have ventolin/salbutamol for the "just incase" .... but I find my salbutamol inhalers are museum pieces and I end up throwing them away nearly full if not full every 6 months (I use powder salbutamol inhalers and once opened they "last" 6 months ..... something to do with milk powder in the inhaler and bacteria)

Chip

[Poobah]

The potency is different between inhalers due to the size of the particles rather than the amount of medicine. This is taken from a potency comparison webpage; Fostair® (pMDI), Fostair® NEXThaler® (DPI) and Trimbow® (pMDI) have extrafine particles. The manufacturer states that 100 micrograms of BDP extrafine in these preparations is equivalent to 250 micrograms of BDP in a non-extrafine formulation. (BDP = Beclometasone dipropionate). Clenil is not an extra fine particle inhaler.

Website: northeast.devonformularygui...

[Celie1 in reply to Poobah]

Hi, that was interesting... I was changed from Duoresp Spiromax 320/9 to Fostair 100/6 which I thought at the time might be a lot weaker. Are these two inhalers comparable then because of the fine particles in the Fostair?

The Fostair didn’t actually help by itself in the end and after a course of pred I’ve had to go onto Spiriva and then recently changed to Trimbow. Do you think the Trimbow will take the whole 8 weeks to get into my system bearing in mind I’ve been taking the Fostair over 2 months?

Sorry to jump onto someone else’s post, but it got me wondering 🤔😁. Thanks 😊

[Poobah in reply to Celie1]

Potency may be the same but we all respond differently to each inhaler. Potency is just one aspect unfortunately and there are websites showing the comparative doses if you want to check. Fostair 100/6 is almost as potent as Duoresp and Fostair 200/6 is more potent. The only way to know if an inhaler will do the trick is to try it out for two to three months. For instance, I was put on Spiriva and for the first three months felt like I could run in the Olympics (I am NOT a keen runner 😄). However, from month 4 onwards I experienced side effects resulting in hypertension. So after some research I asked for Eklira Genuair and its suited me very well in terms of efficacy and no side effects. But that's just me.Trimbow will have a long acting bronchodilator (as in Fostair and other combination inhalers) plus a long acting muscarinic antagonis (as in Spiriva) as well as the steroid. The LABA & LAMA elements should help while your system builds up the steroid.

This is an NHS comparative page for triple combo inhalers against duo combination inhalers; ggcmedicines.org.uk/blog/me... Have a look and see what you think.

My consultant wanted me to switch to Trelegy but I declined as it contained the Spiriva LAMA which gave me hypertension - and we had just discussed my hypertension caused by Spiriva! These triple combo inhalers are relatively new and no doubt different combos will be hitting the market in the future. Currently there isn't one that has my preferred combination so I am very happy to stick with two inhalers.

[Celie1 in reply to Poobah]

Hi, thanks for the reply.

It’s good that you found the Eklira and it works for you. I’ll have to watch my blood pressure if that may be one of the side effects as I’m on medication and have managed to get the meds right down for this and don’t want to have to start increasing.

I was happy to keep on with 2 inhalers, but I felt that he was concerned that there was more room for error (mine in taking it properly, which I do but I don’t suppose he knows that!) which would be amplified if I was taking two. 🤷🏻‍♀️

The link had interesting information in that Trimbow’s not licensed for patients who don’t have a diagnosis of COPD, which I don’t and my asthma nurse thinks it’s very unlikely 🤔 and it advises not to be given to patients which don’t have this diagnosis. He must be using his clinical judgement.

I’ll have to see how it goes 🤞

Thanks

😊

[supersonic32 in reply to Celie1]

I was on Fostair 200/6 and plenty of pred. I started Trimbow 1 and 1/2 weeks ago now. I don't feel any better than I was before. However, I am awaiting a severe asthma diagnosis. So will see what the hospital have to say.

[Celie1 in reply to supersonic32]

Hi, from what I gather it takes a couple of months for new inhalers to work, so we’ve got to give it time. I’m taking ventolin a few times a day and hoping that the Trimbow will work 🤞Hope it works for you too.

Normally after a flare up and loads of pred I start to feel better after a few weeks but this time I’m still getting out of breath and have a chesty wheezy cough on and off. I’m wondering if I should have been given Fostair 200 /6 instead of the 100 /6 when I had my last flare up in December. At that time I was swapped from a high dose: 2 puffs twice a day of Duoresp Spiromax 320/9 to Fostair 100/6 on a MART which didn’t really work for me. I’m wondering if this has caused my latest flare up to continue even after meds. 🤷🏻‍♀️

[Celie1 in reply to Poobah]

Oh forgot to say, I was on a high dose of the Duoresp Spiromax 2 puffs twice a day. 😅

[Birch_ in reply to Poobah]

Oh ok that does make a bit more sense! I guess they wanted to start me on a lower dose to check I don’t have any bad side effects, but it’s not so dramatically different as it seems.

[peege]

Fostair is a MART inhaler. You can use more or less as you need to. Do look up MART to get a proper explanation than I can offer. My life has changed so much for the better since using Fostair. Hardly ever need ventolin now, thinning skin has improved amazingly and I no longer get blood blisters in my mouth. Good luck. P

[Poobah in reply to peege]

Fostair is not exclusively a MART inhaler as some asthmatics don't do well on MART due to a poor response to either the steroids or long acting bronchodilator. Often only trial and error will establish if a patient does well on MART, though some asthma sub types won't do well on it due to their known poor response to steroid treatment. But I'm glad to hear it's worked very well for you.

[peege in reply to Poobah]

Yes. I fully recognise I'm one of the lucky ones but its always worth trying. P

[Poobah in reply to peege]

As you say, always worth trying. 👍

[twinkly29 in reply to peege]

Yes - what Poobah said. It definitely can be a MART inhaler but people should be put on that regime by a nurse or doctor, not something they choose to do themselves. That's quite possibly what you meant anyway though!

[peege in reply to twinkly29]

Just to clarify, I wouldn't dream of choosing my own medication and was horrified to have my prescription changed, agreed to give it a try & never looked back. I had to read a booklet on Fostair from pharmacist and then sign a form stating that I understood the MART system. P x

[twinkly29 in reply to peege]

Oh no I didn't think you would! Just some people don't always read things as others mean them. 🙂