taking seretide (advair) and Qvar together

[runcyclexcski]

Hi all --

Has anyone's GP or specialist ever OKed the use of Qvar and Seretide together?

I've been taking Seretide 500/50 during the current exacerbation and for the last year. It kept me alive, but not enough to work and live a normal life. 3 days ago, out of desperation, I started using Qvar100 as well (had a year-old unopened package), because I did not know where else to turn. I believe the additional inhaled steroid has helped, but it might be a coincidence. Still, the dosages are minimal compared to systemic oral prednisolone, so I figured why not.

Papers say that Seretide hits the upper airways, whereas Qvar hits the smaller airways. Thus, if one's inflammation is in both types of airways, using both inhalers might make sense, at least physics-wise.

Reviews on small airway inflammation state that PF and FEV1 are not sensitive towards small airway obstruction. Thus, I am skeptical about what the NHS Xolair panel will recommend in my case, since they rely on PF and FEV1.

[twinkly29]

I'm on 2 steroid inhalers but my consultant prescribed them to make sure they were the same steroid and hence that the max dose wasn't exceeded. I think you need to discuss it with a GP or maybe the nurses at Asthma UK before just kind of adding in previous medications.

[runcyclexcski in reply to twinkly29]

>>>to make sure they were the same

Thank you, Twinky. Did you mean to say they were not the same steroid (so that the max dose is not exceeded on each one), or am I reading this wrong?

I am generally not trusting my GP to do the right thing. Most of my asthma management so far was me suggesting things to her (oral steroids, xolair, referral to a specialist, referral to a private consultant, sending her my USA medical records etc). Her only suggestion ever was to contact 111. I did switch to another GP 5 days ago who seems to be responsive and knowledgable: he read the EOS counts (known to my previous one to be high for years), and immediately prescribed singulair in addition to what I was taking. Can't hurt, I will add it on. But it surely shows the level of competence of the previous GP. I teach molecular biology to pre-med, and my hair stands up sometimes at who may end up being my local GP.

[twinkly29 in reply to runcyclexcski]

I'd stick with the new one then and try and explain about the Qvar and see what they say - also any other history you want to of they'll listen!

With mine, I used to be on Symbicort and Qvar as a top-up (so I was getting extra inhaled steroid but not extra long-acting bronchodilator/LABA). This was prescribed by a previous consultant. A new consultant changed the Qvar to Pulmicort because Symbicort and Pulmicort are both budesonide, whereas Qvar is beclometasone I think, and he said it made sense to keep the steroid base the same.

In cases where there isn't a steroid-only inhaler that would be the same as in a combination inhaler, maybe some mix and match, I don't know. But I think you need to run it by your new GP (and certainly the asthma clinic at Glenfield when you go) before you start adding in your own things. If nothing else, Glenfield need to see what things are like for you so they can work out the best plan. If you start adding in all sorts now then that might affect things when you go to your appointment.

[runcyclexcski in reply to twinkly29]

OK, I will wait and see.

Last time a consultant at Glenfield tried to work out a plan she asked me to stop seretide (which worked for 10+ years), and to use another inhaler which made my face swell, and I could not open my eyes in the morning. There was no way to contact her directly about this problem, so I just ditched it (problem resolved right away), and asked for another consultant.

[twinkly29 in reply to runcyclexcski]

When you see someone, if they want to try new things or change others, maybe have in mind to ask - how long do I need to give....to kick in fully?

- how should I be be monitoring it so I know if it's beginning to help?

- what might I notice in the meantime?

- what do I do and when if I think I need to see someone?

- when will you review this?

It's easy to think oh I should have asked after the event - I've done that many times! So being forearmed can help in them not assuming it's all known - because obviously it's often not!

[runcyclexcski in reply to twinkly29]

- what do I do and when if I think I need to see someone?

- when will you review this?

Yeah, this makes total sense now. Sorry, I am learning the hard way, b.c. in my prior life I could email my prof directly, without any "administrative assistants", apps, etc. and it's not like he was not a busy person (he runs a pulmonolgy department at the Univeristy of California: medicine.ucsf.edu/people/ho...

Just spent several hrs re-drafting the "astmha diary" excel spreadsheet which Glenfield sent me for the severe asthma clinic. Their scale of PF went to 700. Mine was 700 in the morning (feeling bad), and 940 just now (feeling good, on Qvar and seretide, yoh). Two days ago had to draft a self-report form that Emma has kindly sent me. I guess paperwork is the only way to get to them.

[twinkly29 in reply to runcyclexcski]

It can be really hard because so much is assumed, not just consultants but by the most basic of asthma needs at GP level too. Not every where of course but it's very common - and yes we're all learning the hard way.

Having "evidence" of ongoing peak flows and symptoms is definitely useful. Hopefully this upcoming appointment will be a positive one.

[Pipsqueak77]

Hi

I use Relvar high dose and Qvar 100 - two different steroids as prescribed by my cons. So it is possible but I guess you should wait for advice from your team before adding in.

👍😊

[runcyclexcski in reply to Pipsqueak77]

Many thanks! Alright, so taking two inhalers does not sound unprecedented. So I think I am gonna stick with the extra q-var for now. It's not like I am adding on magic mushrooms or heroin XD.

[ccccc]

Hi

I take Seretide 250 2 puffs twice a day -Seretide alone used to work fine, then didn't! So a consultant added Qvar 100 1 puff twice a day. As you say Qvar is a fine particle inhaler and also more potent than other typical beclomethasone inhalers such as Clenil - but it has helped me a lot and it can be done. GP probably won't do that as it's getting into consultant territory. You just need to be careful when adding in Prednisolone or steroid sprays for hay fever as you can end up taking too much steroid. Also ask about cortisol impact as a high dose of steroid can affect your cortisol levels.

[runcyclexcski]

Thank you, cccc. I believe the Qvar did help, it's day 3 since I have added it to Seretide. I am going to let my consultant know what I did.