PMDI to DPI

[JBrixton]

I've been on Ventolin (Salbutamol 100) and Becloforte/Clenil

(Beclometasone Dip. 250) in a self managed plan for 31yrs and asthma nurse suggested changing to DPI Easyhalers as it's more environmentally friendly.

These are Beclometasone 200 and Salbutamol 200. I have asked GP why Bec. is 200 and am told there isn't a 250 but 200 DPI gets into the lungs better. If 200 x 2 doesn't work as expected I should go up to 3x.

(I have perfect PMDI technique, keeping tongue low, accurate timing, no spacer needed.)

I have DPIs now and am shocked at the effort needed to inhale them. I don't think I want to try sucking on these if I get a chest infection, which is when I am at my worst. That's when I jump up to 2puffs 4x daily of Clenil and as many puffs as necessary of Ventolin, at this point I would also get Prednisolone and antibiotics.

Is this how DPIs are or should I ask for something easier?

Will I notice a difference in effectiveness even though they are actually the same drugs?

Although the Easyhalers are coloured blue and beige on the top, they both have white bodies and blue mouthpiece caps.

Everyone knows blue is the reliever, did someone miss the boat on this one?

Thanks peeps in advance.

[Poobah]

I've been on DPIs for about 40 years and technique is everything because delivery is inhalation dependent. I think if you're not dependent on a spacer to deliver your aerosol inhalers then you will cope with the DPIs, even when you have a flare up or chest infection. I've never felt I didn't get a full dose (unless the inhaler missed a dose, but that's easy to resolve by taking again - rarely happens).

If your asthma is usually controlled just with a steroid inhaler with occasional Ventolin then that's probably why your asthma nurse is confident enough to prescribe DPIs.

The potency can be stronger in DPIs to aerosols so going by the mcg isn't a straightforward measurement. The powder is finer than liquid droplets, hence the assertion that the DPIs are inhaled more effectively.

The steroid is the same one that's in Clenil so you shouldn't experience a dip in treatment effectiveness, but if you still feel like you're not getting along with the treatment after a few weeks then go back to your asthma nurse.

And good oral hygiene is very important when it comes to DPIs, not just because of the steroid but because of the lactose carrier. Always brush your teeth and rinse thoroughly after use.

[JBrixton in reply to Poobah]

Thank you for the very clear answer I needed. Very helpful.

I'll see how I go and give it a couple of months.

Cheers.