I was wondering….

[Willow7733]

I am currently on Dulera and Singulair. For rescue, I take Ventolin. The last appointment I had with my asthma team, the pulmonologist added Qvar to my Dulara. Singulair and Ventolin stayed the same. Has anyone had puffers added to their everyday maintenance puffers, and what classification would this put me in for my asthma? Moderate? I have had three rounds of prednisone in the past 9 months , (and 9 pulmonary embolisms not asthma related).

[Poobah]

In the UK the Stepwise Asthma Management plan would normally step up from the combination inhaler (Dulera), Singular (Montelukast) and Ventolin by adding a LAMA inhaler such as Spiriva rather than adding a steroid only inhaler (Qvar). However, Dulera comes in 100/5 & 200/5 strengths so if your doctor wants to limit your long acting bronchodilator dose and increase your steroid I can see why they would add a steroid only inhaler in order to achieve that. Only your doctor can explain why they've chosen the additional steroid inhaler rather than any other options.

General, adult daily dose of between 400 micrograms & 800 micrograms of mometasone is considered moderate by NICE. So depending on your Dulera & Qvar daily dosage you'll either be in the moderate or high doseage bracket in total.

There's been much debate, thanks to covid and the decision as to where to draw the line between moderate and severe asthma, depending on hospital admissions, oral steroid requirements and number of asthma medications prescribed. Repeated need for oral steroids and hospital admissions suggest that the patient's asthma in not controlled and requires additional treatment. There's a self assessment tool in this helpful piece from the American Lung Association: lung.org/lung-health-diseas...

I would give your new regime a good 8 weeks before following up with your doctor as Qvar is a different steroid and will take a few weeks before you show any improvement in your symptoms. Always good to have follow up appointments planned so that expectations can be assessed and any adjustments to your medication can be made, if necessary.

[Willow7733 in reply to Poobah]

Thank you so much…I feel better knowing this is normal. The add of Qvar really is helping. My Dulera is 200/5. And I was using my rescue inhaler around 7-8 times a week on it. Now, I am down to 3 times a week. Which, to me, is much better. I didn’t know it was a steroid, but now that you mentioned it, it makes sense. It feels like my Ventolin when I inhale it. (If that makes any sense at all). Thank you for helping me make sense of it all.

I have a good team. The Repiratory techs call me regularly to check up on me and she did just recently. She was checking to see how the Qvar was working. Depending on the phone appointment with her, she contacts my pulmonologist, and they set up follow up tests. I am pretty impressed at how they are organized and really amazing to work with.

[Poobah in reply to Willow7733]

Well, it sounds as though the additional steroid inhaler is what you needed if your Ventolin use has reduced. Having confidence in your asthma team is a real blessing and it's great to hear a positive experience. All the best.

[twinkly29]

It's very common to have preventer medication changed (added, switched or removed), in fact it's just normal asthma care. Everyone has times where they need additional or different treatments.

It's perhaps less common to have additional inhaled steroids on top of another steroid or combi inhaler (often the dose of the original one would just be increased or a different add-on would be tried) but it depends on the individual and extra inhaled steroids can be used to maximise the inhaled steroids in order to reduce the need for prednisolone because inhaled steroids are much better for us.

Some people are on just one inhaler, others are on more, It's not really anything to do with severity but it is to do with control and to get that the right combination needs to be found.

[Willow7733 in reply to twinkly29]

That is what I was thinking. Dulera is a good combo medication I am told and to add the Qvar, didn’t know if that is a regular thing they do. I am on the 200/5 dose of Dulera, so maybe I just needed that little extra boost of steroid? I really didn’t enjoy taking prednisone. I felt awful on it, but at the time, I was willing to do anything to get some relief. Thank you for the information. I feel much better talking to people in the know. I really am new to all of this.

[twinkly29 in reply to Willow7733]

I have no idea about Dulera - not sure if we even have that in the UK to be honest!

[Tree20862]

My pulm doc talked about adding qvar at one point the next time I got sick and then I ended up staying on it. Her thoughts were more steroids in the lungs and maybe I would need less oral steroid therapy. At the time, it did not work but Xolair did. I'm still on symbicort and arnuity.... Insurance decided that they would cover those drugs better. I'm States side😉