Fostair excessive use maybe? - Asthma Community ...

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Fostair excessive use maybe?

Bea2000 profile image
15 Replies

Hello, I've been using fostair 200/6 for a while now and fostair 100/6 as my reliver. Both aerosol. Along with some other asthma and allergy meds.

I recently moved home from university, where this treatment was prescribed.

My home asthma nurse didn't flag anything he first 2 appointments. I recently requested a new reliever (fostair 100/6). My GP flagged this and said I couldn't have that as I'm already taking fostair 200/6 two puffs twice a day. They said I had to use a blue inhaler instead-one has not been prescribed. My mum picked up some other medicines for me this morning and non of my asthma medication was in the bag. Despite ordering them a few days ago and being approved.

My GP also changed my fostair 200/6 aerosol to a nextinhaler (dry powder) I don't remember being asked about this change- stating that's what they use here unless "physically proven I can't administer it properly".

I've been taking it for a few days and can't take it without gaging and wheezing.

I have an appointment with the asthma nurse in 2 weeks - any advice would be great!

At university I was being treated at the hospital by the respiratory department as they said I shouldn't be under the GP, that has not been mentioned since coming home.

Not sure what to do as I'm going on a long holiday in the new year to cold countries where I'll be skiing and walking in the cold.

If you have any advice I would really appreciate it.

15 Replies
Lysistrata profile image
LysistrataAdministrator

Hi Bea, that sounds really frustrating!

The regimen you have at uni does sound a bit odd to be honest, as only Fostair 100/6 is meant to be used for a maintenance and reliever (MART) regimen, by itself and not with 200/6 alongside - so I can understand why the GP at home wasn't keen on it. At the same time, I think they should have asked and discussed it with you before changing, particularly if it was consultant prescribed. Being consultant prescribed by itself doesn't necessarily mean it's right - I have had some very odd regimens from consultants which didn't really work for me and were a bit old-fashioned. However, it still isn't for the GP to just change things without discussing it and hearing why it's been prescribed that way and how it works for you (does it work for you?) This page on MART may help, though you may already know some of it: asthma.org.uk/advice/inhale...

Your GP also shouldn't have just switched you to dry powder without asking! It should be about what works for the patient, not 'local custom' for everyone at the practice and the patient having to prove something that way before they get what works for them. And it can vary - some people can use dry powder some of the time, but not when they're struggling, and the inhaler they use needs to take that into account. I used to be on Symbicort (as a preventer not MART) and I struggled to take it when I was getting worse. I find Fostair easier, but if I were using it as a reliever too I would probably struggle to get that in too if my breathing was bad.

I especially am not impressed with this given that you're moving between two GPs because of uni, and they seem to have completely ignored the fact that you are seen by someone else during term, plus the respiratory department. I always thought the uni GP was the main one too, and you had to register temporarily with home one, but I was at uni nearly 20 years ago (omg) so that may have changed.

Re the medication not being available - did the pharmacy say anything to your mum when she collected it? Sounds like you'll have to ask them and then the GP what's going on (if you take anything less common, it can take some time to get in, and not all pharmacies tell you that unless you ask them). But it's pretty poor that you haven't been prescribed the reliever either - I would definitely get onto them asap about that and ask for it to be prescribed.

I wonder if it would also help to ask the pharmacy for any advice on using the Nexthaler, if you have to use that meanwhile. Even if you end up back on aerosol it might take some time to sort out, and if there's a way you can use it without gagging then at least you'll be getting some medication in.

Can you get an appointment any sooner with the GP to discuss all this, and point out you're struggling to actually use the Nexthaler so aren't getting your proper preventer dose? Hopefully you can sort out your other medication meanwhile, but it isn't great that you're left with a medication you can't use currently. I'm also wondering if you have any way to get in touch with the respiratory department from uni and explain the situation, and if they might be helpful at all?

Meanwhile, I'd strongly suggest you call the asthma nurses here 0300 2225800 or WhatsApp 07378 606 728 Monday-Friday 0915-5pm YOu can chat through the situation and they can advise how to approach your GP and next steps.

Bea2000 profile image
Bea2000 in reply to Lysistrata

Thank you so much!

Whilst at uni I was only allowed to have 1 GP, so I choose the one at university. After moving back none of my medications were on repeat and all my notes have been taken off the NHS app.

I have spoken to asthma UK who agreed with my current GP that what I'm currently doing is not allowed. As I'm taking too much fostair.

Thank you for the help!

Lysistrata profile image
LysistrataAdministrator in reply to Bea2000

I thought they might not be too keen on that, but you need something else to replace it - and you can still take aerosol Fostair even if not MART! I hope they had some useful advice for your asthma nurse appt and the other issues.

Bea2000 profile image
Bea2000 in reply to Lysistrata

Thank you so much!

Wheesy profile image
Wheesy in reply to Lysistrata

I have a number of Lung and Heart Problems and My Excellent Specialist/Consultant prescribed Fostair 200/6 {Preventer} and Fostair 100/8{Reliever} and Ventolin along with Benra, and other medication and although other clinititions try to alter my medication I just say that if they do that my Consultant will have to be consulted first before they can change any medication,and they very quickly change their minds. I suggest that you request an appointment with a consultant, and in the meantime do not stand on cerimony with the asthma nurse and insist that all your medications are reinstalled as you do not suffer as much with your current prescription. In the past I have had reason to tell clinititions that I would contact the onbudsman about what they are trying to do and it was amazing how quick they changed their minds.

Poobah profile image
Poobah

My asthma nurse recommended adding Fostair 100/6 as a reliever in my last review, and I'm already on Fostair 200/6. She explained that there's a move away from Ventolin type relievers. However, my GP didn't approve this and I remain on Fostair 200/6 ×2 twice a day (my asthma nurse considers this to be a moderate dose) in addition to Ventolin (about 2 inhalers a year).

There are several videos on YouTube showing how to get the best out of the Nexthaler. It has extra fine particles, so is able to be inhaled further into the lungs. Always important to rinse thoroughly after use, some use salt water but I always brush my teeth.

In respect of dental care while prescribed steroid inhalers, there are toothpastes and mouthwash available that contain higher amounts of fluoride which can tackle the side effects caused by these inhalers. Oral B have just launched Densify toothpaste and I use this, but Colgate have Duraphat toothpaste and Fluorigard mouthwash, both contain higher levels of fluoride.

As for not receiving your asthma meds, best talk to the pharmacy to see what prescription they actually received, just in case the error is theirs and then talk to the GP in order to get your meds quickly reinstated and the necessary prescription issued. The receptionist should be able to make a same day telephone appointment if you explain that you're an asthmatic and the necessary meds have been overlooked and as these were prescribed by a consultant it's important to make sure that the GP is aware of all the facts. I've known letters from consultants to be overlooked or only the first page quickly scanned, missing prescription instructions on subsequent pages. And if you're still struggling with the dry powder Fostair, you'll need an aerosol inhaler as a matter of urgency.

When you do have your asthma nurse appointment, make sure you discuss everything you think is important to you, especially if you want them to follow your consultant's advice.

Rachiejo87 profile image
Rachiejo87 in reply to Poobah

Hi there,

I'm on Fost 200/6 ×2 twice a day then Fost 100/6 up to 6 times a day as a reliever if required.. It sorts me out.

I was unable to control my asthma back in 2019 which is why I was switched up to that. At the same time my bloods were taken and as a result I was put onto Montelukast which has changed my life. My pef on average 570 each day.. I'm a 35 year old female, stand at 5'4..

My assessment was done at the hospital. I am looked at very quickly these days as I was unfortunately ventilated for 10 days with an asthma attack.

I hope you get things sorted.

Rachel

Anselm198 profile image
Anselm198 in reply to Poobah

The dental hospital in London told me that not all high fluorides are recommended for asthmatics. It's important to check with the dentist or GP before starting.

Bea2000 profile image
Bea2000 in reply to Poobah

Hey!Thank you so much everyone for replying!

I think I was getting a it fed up when I wrote the post 😂😂.

As when I was at uni in a city, I was immediately referred to the hospital, given a steriod card and got my latest covid booster with the over 50s (I'm 22).

Whilst my GP at home in the countryside I've never been referred to the asthma specialist at the hospital, had my covid jab with my age group and wasn't given a steroid card.

So it was a bit of a shock!

I do think the transition of changing GP wasn't very smooth 😂😂

All of my repeat prescriptions had been taken off of repeat so that was a bit of a hassle.

I'll look into what tooth paste I use and talk to the asthma nurse - thank you for the tip!

And I'm planning to change back to aerosol inhaler as I can't get the hang of dry powder 😂😂

Troilus profile image
Troilus

Hi Bea. I would give the respiratory clinic you attended while at university a ring.

1. I would ask them to write or better still email your GP to inform them of your medications

2. Ask them if they can transfer you to a hospital near where you are now (assuming you are finished uni.)

Like you I am under a consultant and have reviews in clinic (or more recently on the phone) and they determine my treatment. I am also on Fostair 200/6 2 puffs twice a day and I have a Fostair 100/6 to use up to 4 times a day ( 4 puffs) I also have salbutomol. (This was called an adjusted mart regime by the hospital)

The salbutomol and the Fostair 100/6 are on open prescription i.e I can get them whenever, where the Fostair 200/6 is strictly I per month.

Bea2000 profile image
Bea2000 in reply to Troilus

Hey,Thank you for the advise!

I have finished uni and when I changed to my current GP I bought all my paper medical letters I'd been sent and asked if they wanted a photo copy of anything, they said they had it all.

I'll take it with my again for my asthma nurse appointment!

Seems a lot of people are on both fostair 100 and 200.

I did speak to asthma UK who said you couldn't be on both. My GP said the maximum is 800 per day.

Thank you!

Troilus profile image
Troilus

Strange asthma U.K. don’t know about it. Mine was prescribed by the respiratory clinic at the hospital.

I don’t take the 100/6 on a daily basis, but as an add in when my peak flow starts to slide. So far, it has worked well for me and I have avoided having to take oral steroids which is what this is designed to avoid.

Initially I took extra doses of my 200/6, but they thought this might be better - choosing the dose to match where I was at. Seemed sensible to me - why take more than you need.

The asthma nurses I think must be working off the standard dose. This increased dose I think is what is referred to as off licence.

Bea2000 profile image
Bea2000 in reply to Troilus

That's interesting! I'm so glad you've avoided oral steroids! That's always good

DollyDutchGirl profile image
DollyDutchGirl

I have been with a consultant at a Respiratory Clinic for the past three and a half years - trying to find a regime that suited me. Having been steady for six months, I was signed off - with the understanding that I should contact her secretary immediately should I find things becoming troublesome - to make an appointment at the clinic. The current armoury consists of Fostair 200/6 2 inhalations twice daily - plus, up to four inhalations throughout the day (as Mart), Montelukast 1 at night, Carbocisteine 2 capsules x3 times daily, Omeprazole 1 x a.m and p.m, Tiotropium Bromide (Spiriva) 2 inhalations a nighttime. Mometasone nasal spray x twice daily - plus of course, Prednisone, that is used as and when needed….(which is appropriately around 4 times a year)…..always remembering to keep an emergency pack to hand. I, like many other people - also have a host of other necessary meds for ailments I’ve gathered along my journey towards old age. Needless to say, I’m incredibly grateful to our NHS for taking such great care of me, especially over the past few years. I’m also extremely grateful that I no longer need to pay for all of the medications I need each month….

Bea2000 profile image
Bea2000 in reply to DollyDutchGirl

I hope your new regime is helping you! Definitely, the NHS is amazing!I get a pre payment certificate annually as I also have a lot of prescriptions.

I think there is a lot of variation between hospitals and GPs about what medications can be used together etc. I guess that's to be expected with the amount of new medications that have been approved! It's amazing to see the amount of medications currently available for asthmatics.

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