My combination inhaler is fostair 200/6 2 puffs twice a day. I carry a steroid card because I take this inhaler. However when I asked for another steroid card to put with my ventolin from the pharmacy yesterday, the pharmacist told me I don't need one.
I am confused as I was told by asthma UK that I need to carry one. Who is right?
I got given a steroid card when I was put on my current prensidone course, of 26 days including wean.
I have not been given a card for a short prensidone course or for fostair 200.
I also carry a steroid warning card due to my inhaler (symbicort) but I don’t need one for ventolin because that is different medication. Even IF it was required (which it isn’t) I don’t understand why you would need 2 separate cards??
So I carry a blue steroid card but only since being on Prednisolone on a permanent basis due to Adrenal deficiency I have never been told to carry a steroid card when on fostair inhaler so maybe I would speak to gp or asthma nurse to get there point on this as I know it can affect other medication and I know dentists are interested in knowing about steroids as it causes problems with dentistry health but I never was given a steroid card to being a low dose steroid inhaler but like I say things change all the time with asthma and treatments and information I hope this helps you good luck I struggle to get salbutamol nebules in community so I think it is a very difficult time for anyone poorly needing support from the nhs who are stretched beyond stretched
I also carry a steroid card due to having many long steroid courses, then for being on long term pred. I also now have adrenal insufficiency so I wear medic alert ID and carry a steroid card as advised by my endocrinologist
When Should I Issue a Steroid Emergency Alert Card?
Each item listed below gives the drugs and doses which require a Steroid Emergency Alert Card to be issued.
Decisions to issue cards should be made for each patient individually and specialists may suggest an alternate
course of action. Steroid cards should be carried for 12 months after stopping treatment.
Patients may be on 2 or more steroid items which cumulatively would warrant them to have an alert card so this
must be calculated. See overleaf for example of how to do this
Oral: Prednisolone ≥5mg daily* Any PO steroid > 3 courses in 12 months
Dexamethasone ≥0.5mg daily* Hydrocortisone ≥15mg daily*
Budesonide ≥1.5mg daily* Methylprednisolone ≥4mg*
Fludrocortisone ≥0.1mg daily* Deflazacort ≥6mg daily*
Beclometasone ≥625mcg daily* Betametasone ≥750mcg daily*
Inhaled ONLY: Beclometasone >1000mcg daily Extra Fine Beclometasone (Qvar/Kelhale)** >500mcg daily
(Clenil/Soprobec/Easyhaler) Extra Fine Beclometasone (Fostair/Trimbow)*** >400mcg daily
Budesonide >1000mcg daily Ciclesonide >320mcg daily (Alvesco)
(Symbicort/Fobumix/Duoresp, etc) Fluticasone propionate >500mcg daily
Fluticasone Furoate >100mcg daily (Seretide/AirFluSal/Sirdupla/Flixotide/Fusacomb etc)
(Trelegy/Relvar Ellipta) Mometasone >800mcg per day (Asmanex)
Inhaled in combination with any steroid nasal spray, steroid injection, potent or very potent topical steroid:
Beclometasone >800mcg daily Extra Fine Beclometasone (Qvar/Kelhale)** >400mcg daily
(Clenil/Soprobec/Easyhaler) Extra Fine Beclometasone (Fostair/Trimbow)*** ≥400mcg daily
Budesonide >800mcg daily Ciclesonide >320mcg daily (Alvesco)
(Symbicort/Fobumix/Duoresp, etc) Fluticasone propionate >400mcg daily
Fluticasone Furoate >100mcg daily (Seretide/AirFluSal/Sirdupla/Flixotide/Fusacomb etc)
(Trelegy/Relvar Ellipta) Mometasone >400mcg per day (Asmanex)
** Beclometasone dipropionate (BDP) via Qvar/Kelhale is approximately twice as potent as BDP in standard particle CFC-free inhalers.
***BDP via Fostair/Trimbow is approximately 2½ times as potent as BDP in standard particle CFC-free inhalers.
Nasal: Fluticasone furoate 27.5mcg 4 sprays per day for > 7 days (Avamys)
Fluticasone propionate 400mcg/unit drops 2 nasules per day (Flixonase nasules)
Note: other nasal sprays do not reach threshold at standard licensed dose+
Rectal: Prednisolone rectal foam/suppositories ≥5mg per day
(Suppositories/foam enema/rectal solution)
Budesonide enema/rectal foam ≥2mg per day
(Budenofalk/Entocort)
Note: other rectal preparations do not reach threshold at standard licensed doses
Topical: Very potent -200g per week+
Clobetasol 0.05% (all forms) (Dermovate/Clobaderm/Etrivex)
Potent - 200g per week+
Betamethasone (all strengths/formulations/salts) (Diprosone/Betnovate/Bettamouse
/Diprosalic/Fucibet/Dovobet/Enstilar/Lotriderm/Dalonev/Betacap/Audavate)
Fluocinolone acetonide 0.05% (all forms) (Synalar/Synalar C)
Fluocinonide 0.05% (all forms) (Metosyn/Metosyn FAPG)
Fluticasone propionate 0.05% (all forms) (Cutivate)
Hydrocortisone butyrate 0.1% (all forms) (Locoid)
Mometasone 0.1% (all forms) (Elocon)
If any of the above treatments are applied to rectal or genital areas at a dose of ≥30g per month, a steroid
emergency card should be issued
+NB. Figures quoted are from SPS article. PrescQIPP guidance differs and says 50g per week for very potent and 75g per week for potent. Local
dermatologists advised to use the SPS figure.
NB: Patients may
be using MART
therapy
*> 4 weeks
duration
When should I issue a steroid emergency card?
Date produced: May 2021 Review date: May 2023
Page 2 of 2
Injections: ≥3 intra-articular/IM glucocorticoid injections in last 12 months
Eye/Ear Drops: Prednisolone 0.5% ≥1ml (~20 drops) per day for > 7 days
(Minims/generic)
Prednisolone 1% ≥0.5ml (~10 drops) per day for > 7 days
(Pred Forte)
Note: other drops do not reach threshold at standard licensed doses
It may be helpful to know threshold doses for other nasal preparations to help calculate cumulative steroid doses:
Nasal: Beclometasone >1000mcg daily Budesonide >64mcg daily
(Beconsae/Nasobec) (Rhinocort Aqua)
Fluticasone proprionate >500mcg daily Triamcinolone 4mg daily
(Flixonase/Nasofan/Pirinase) (Nasacort)
Mometasone furoate >500mcg daily (Nasonex)
If any patients are on these medicines + a steroid (at ANY dose) a steroid emergency card should be given:
Clarithromycin – continuous treatment Atazanavir
Itraconazole Darunavir
Ketoconazole Fosamprenavir
Voriconazole Ritonavir (+/- lopinavir)
Posaconazole Saquinavir
Tipranavir
Cumulative dose calculation
Many patients will be taking a combination of steroid products. In this case we must attempt to estimate the
equivalent total steroid dose by calculating the ratio of the dose taken compared to the threshold dose. See below
for worked example.
Worked example 1:
Patient is prescribed prednisolone 2.5mg daily and Fluticasone furoate nasal spray 27.5mcg 2 sprays per day.
Prednisolone 2.5mg is 0.5 threshold dose. Fluticasone furoate 2 sprays per day is 0.5 threshold dose.
0.5 + 0.5 = 1.0 threshold dose.
Therefore issue steroid emergency alert card
Worked example 2:
Patient is prescribed beclometasone nasal spray 2 sprays BD (200mcg), Clenil 100 inhaler 1 puff BD (200mcg) and
oral prednisolone 3mg daily.
Nasal spray is 0.2 threshold dose. Inhaler is 0.2 threshold dose. Prednisolone is 0.6 threshold dose
0.2 + 0.2 + 0.6 = 1.0 threshold dose
Therefore issue a steroid emergency card
Thank you for posting this, having checked I need to carry my blue card all the time, not just when I’m taking Pred.
Hi elanaoali, 'rightbreathe.com' is really useful for info on steroid cards, I'll send link, just click on inhalers. rightbreathe.com/
Found my answer on asthma +lung uk site which says that if you use a high dose preventer inhaler long term. Its been 3 years of taking this inhaler. So I will be carrying a steriod card. This is my old one I carry in my pursue
cataracts b.c. of long-term steroids
Tapering off inhaled steroids due to steroid induced adrenal insufficiency
Steroid Inhalers and Thyroid levels 
2x Emergency Steroids in one month 
Oral thrush and Inhaled steroids 
