Switching preventers

[lucia_m]

My consultant has recommended I switch from Fostair 200/6 to Relvar Ellipta 92 as I’m getting too many nighttime symptoms. His rationale is that I’ll get more steroid from the Relvar and hence will have better control following the switch. I’m confused, though, because as far as I can tell Relvar 92 is a lower dose of steroid than Fostair 200 according to comparison charts. My GP is going to write to him for clarification, but I wondered if anyone here can shed any light - am I missing something about the comparison, or is this likely to be a mistake on the consultant’s part?

[Poobah]

There must be a mix up if the consultant does mean to increase your inhaled steroid. As you quite rightly point out, Revlar 92 the has much less inhaled steroid than Fostair 200 per dose. Even the stronger Revlar184 isn't equivalent in strength to Fostair 200, but it does contain more long acting bronchodilator antagonist (LABA). And because it does have a high level of LABA it means there are restrictions on doses - in order to achieve high steroid you'd be taking a lot of bronchodilator.

Thankfully, your GP has asked for clarification.

[Pipsqueak77]

Hi lucia_m

I think that your cons is correct.

The Fluticasone in Relvar inhalers in is in the form of fuorate which means that it has a much higher potency than other forms of steroid.

So despite seemingly lower dose amounts of steroid the actual effacy is higher due to higher potency.

If you search you will find the equivalents with regard to other steroids…I’m afraid I can’t remember off the top of my head! Sorry!

However I know the info is out there… and I know that Relvar 192 just one puff per day is classed as a high dose steroid for this reason. That is why only one puff is required and this is why I prefer it.

Hope this helps….

😊👍

[lucia_m in reply to Pipsqueak77]

Thanks for your reply. I'm aware that the furoate is a very potent steroid, but I think the potency of the 92/22 Relvar inhaler is still lower than Fostair 200 (this chart from the BTS would seem to indicate so, anyway: brit-thoracic.org.uk/docume.... I guess I'm questioning why the cons hasn't recommended the 184/22 dose. Hopefully the GP's query will clear things up. They do have a tendency to defer to the cons though (understandably) so I'm a little worried that they won't push hard enough. Guess I'll just have to cross that bridge if/when I come to it, though.

[Pipsqueak77]

Hi lucia_m

Well personally I would give it a go…. you may not need more steroid if you find a more effective inhaler for you🤷‍♂️ and ultimately it’s all about using the lowest doses possible of steroid to control your symptoms….

Good Luck👍