Managing trial seasonal reduction of inhaler

[Wheezycat]

Good morning!

Summers, for me, are such a relief compared to wintertime. I don’t do well with the cold (and damp?) weather. Thus I have agreed with a GP that it would be good to reduce my inhaler now it is warm again. He suggested it after a lung function test which he interpreted as me having mild asthma. I also spoke to a AUK nurse who did not see it that way. I trust her more, as it felt as if he was using a flowchart approach to ‘standard’ expectation of asthma symptoms.

Since last October I have been monitoring my PF twice daily, and while nothing has been dramatic it had a max of 375 then to a max now of 330, and it has plateaued. That is not exactly dramatic, but the AUK nurse felt that was worth taking seriously. I am still hoping that with the warmer weather I will regain 375 or thereabouts. It would reflect how I feel.

However, I started reducing, to 3 puffs of Fostair 200/6 in 24 hours from 4 puffs, and now, of course, I don’t know if that stopped my PF improving or if it is caused by my reduction in Fostair intake or not. The AUK nurse suggested I go back to 4 puffs to get my seasonal optimal pf first, then reduce slowly again. Only, I don’t know what my current optimal would be.

How do others on here manage these things?

[Fruitandnutcase]

I used to cut back in my preventer when I was ok and not wheezy and the practice pharmacist who did my asthma checks didn’t recommend doing that. She said to take at least one puff of my Clenil every day to keep my lungs ‘primed’ so that’s what I do now. Mainly because I didn’t like the idea she put forward of suddenly being hospitalised and needing steroids although to be honest I couldn’t see that happening - it never happened in all the years I’ve operated that way.Last asthma check it was suggested I have a lung function check - no dates were mentioned though so who knows. I think I’d probably do what you’re doing and follow the asthma nurses advice.

[Wheezycat in reply to Fruitandnutcase]

Thank you for responding. I have never stopped altogether, nor reduced. I would only do that if discussed. But for me everything feels loads easier in warm, dry weather, and last summer I questioned if I needed the dose I was on while it was warm. Winter is hard work and exhausting for me. But my pf has even started reducing a bit thus my contacting the AUK nurse. So I am back on full dose for now. The GP may not like it - if it comes to that I will try to contact an excellent asthma nurse attached to the surgery group, but that is for the future.

[Lysistrata Administrator Community Ambassador]

Not sure I have any useful advice on reduction, except to roll my eyes at the GP. You don't diagnose 'mild asthma' from spirometry alone - sounds like he's got COPD on the brain using it that way, and even then it's more complex. There are guidelines about asthma severity but the way they measure it (eg spirometry, night wakings) seem to be more linked to control than underlying severity.

To be honest, assuming no prior fixed airway damage, your lung function could and even should be normal if you're well controlled on meds, so not even showing mild obstruction (if that's what he meant by mild asthma...in which case🙄because asthma isn't just obstruction, even if you leave aside various other issues relevant to spirometry interpretation. And even if you weren't well controlled, it's a snapshot. There are people on here with severe asthma who can have normal or better than normal spirometry at times, and low at others - it doesn't mean they have mild asthma or should reduce meds.

I would go with what the AUK nurse said if you can, and if you get pushback from the GP, tell them what she said - it seems to have worked quite well on someone else's GP, based on another post! I appreciate you're feeling better, but that's the problem with asthma meds - if they work like they should, you (generic you) start feeling you don't need them!

[Wheezycat in reply to Lysistrata]

Thanks, Lysistrata. I think that was exactly how that GP judged it. He kept asking me if I had dropped my inhaler for 12 hours as instructed (I had) , and seemed surprised when my reaction wasn’t strong. I did suggest to him that steroids don’t completely clear the system in just 12 hours! So I am fine with that. Luckily we do have a brilliant asthma nurse specialist attached to the surgery group (she teaches about it at our local med school I believe), and if needed I will try to get hold of her. It may well not be necessary.

Summers and warmth tend to be good to me so a seasonal improvement was expected, but my pf tends to reflect how I feel albeit not in a dramatic way, but it is not improving now even slightly just now in spite of plenty warmth and a dry atmosphere. Thus I have returned to full dose as of today, as per suggestion from the AUK nurse. The AUK nurses are so great!

[Hidden]

When I was on flixotide 250 I needed a total of 1000mcg a day (so 2x2 actuations a day) from around October to May. In late spring I was usually able to taper off the medication to 750mcg (so 1 actuation in the morning, two in the evening), for around 4-6 weeks and then if things were feeling good I was able to drop it again to 500mcg (2x1 actuation a day). That would normally see me through until around September when things usually had to be stepped up again to one actuation in the morning and two in the evening until it had to be increased again for winter. Inevitably there was some variation on the timings from year to year. My GPs knew I was doing this and also knew that, having had thirty plus years of dealing with the condition when I was put on Flixotide 250, I knew my condition well enough to judge when to increase/decrease the dose. Looking back on it I think it helped that one of those GPs was himself asthmatic.

[Wheezycat]

Hi MaggieHP and thank you for your comment. It is describing really well where I want to get to. I started to race to 75% of my standard dose, but my pf not only di not improve with the warm weather, but even reduced slightly. None of this was in any way major, and could he been just a coincidence. I am lucky in that my pf broadly tends to reflect how I am with my asthma, even if there are no dramatic falls or rises. I had expected it to rise with the improving weather but it hardly did. Having been a cold spring all this started later than I had hoped. Your timings are what I would anticipate are broadly right for me. And I still hope to get there. The GP I spoke to wasn’t the one I normally see, though I have had the occasional contact. My normal one is fine albeit not perhaps so very up on asthma. There are some good asthma nurses though. We belong to a huge surgery group that includes loads of local surgeries, so it is hard these days to have any control over who you speak to when something comes up.

[peege]

Hi👋, I'm similar to you in that my asthma is far worse in the winter. I love Fostair, I've hardly needed Ventolin since starting it over 4 years ago. I was given a booklet with my 1st Fostair on how to use a MART inhaler then 2 years later a new booklet from my respiratory nurse. I love that I can take more or less as I need as well as take as a rescue, so far its worked brilliantly. My dose is 2 puffs of 100/6 morning and night. In the winter I'm fine with 2 at night and just one puff in the mornings, sometimes if unwell I might take 2 in the morning. Summer (a bit later in starting this year) I'm good on 1 puff morning and 1 night. I may be wrong but possibly not all Fostair doses are MART.

I'd follow asthmauk's advice, get your peak flow back to normal before you experiment. Good luck. P

[Wheezycat in reply to peege]

Thank you, peege. I am on Fostair 200/6 twice morning and twice at night. That is a maximum normal dose, so if anything happens I do need to contact the surgery. I used to be on Symbicort 200/6 SMART regime at the same number of puffs as now and that I could vary as I felt I needed it. I loved that! Currently all I can do is decrease from my current dose.

[peege in reply to Wheezycat]

Ah, shame. I guess I'm lucky to have moderate asthma. P

[Wheezycat in reply to peege]

Hi again, yes, that is me as well. But wintertime a lower dose seems not to help sufficiently, especially for going for walks and such. I have struggled many times, and then felt exhausted for the rest of the day or more. I also react on indoor air pollution, notably anything that involves roasting/baking/toasting, or burning candles or incense or such, and, of course in winter we don’t keep all windows open most or all the time as we do in summer, so it builds up over time. I even had a sudden asthma attack on Christmas Day due to cooking fumes and candles! Now I am changing my cooking style and I think that is helping. In summer that is, of course, easy. Anyway, it was these reasons I ended up on a higher dose.

[peege in reply to Wheezycat]

Ah I see, I'm similar but not nearly so sensitive. My windows are firmly closed in winter against cold & damp, my main trigger plus mould. I find natural lavender oil helps with cooking smells & my daughter bought me a very expensive candle once and that was OK but otherwise avoid most pongs & fumes. Take care. P