Qvar for asthma plan

[nmcv13]

Hi, I’ve been asthmatic for 9 years since I turned 50. I’m on fostair 200/6 x2 twice a day plus montelukast and fexofenadine. My asthma management plan now includes Qvar 100 x 12 puffs twice a day if I’m struggling. My asthma mostly manifests as a cough. I had a severe coughing experience for several hours after a meal out a week ago. This continued at a reduced level throughout the week so I started Qvar 4 days ago. I’m still coughing but less than before. I’m curious re others experience with Qvar as part of an asthma management plan.l am wondering how long to keep taking it and when to escalate if necessary. I don’t feel bad enough for steroids but the cough seems quite stubborn. Thank you

[MarmiteMalice]

Hello! I’m new here and this is my first post.

I apologise that I don’t think I have any answers for you. But I just wanted to say that just reading your post has made me feel a bit better about what I am experiencing.

I was diagnosed with asthma in April 2023 at the age of 41. I’ve had lots of people saying that it can’t be asthma or that it’s somehow unusual because of the later in life diagnosis. So it’s good to know that I’m not the only one with a later diagnosis. I also feel like there is a lot of conflicting information and different presentations of asthma, so it’s so confusing with all the different protocols and types of inhaler that are available.

I was initially prescribed a Qvar 100mcg inhaler in A&E at the end of 2022. I Had presented at A&E 3 times in as many months, and despite having a Salbutamol (blue) inhaler I was still waiting for spirometry to diagnose asthma. When I finally had the results of the spirometry (it took almost 4 months!!!), my GP stopped the Qvar and started me on Fostair 100/6 (2 puffs twice a day). My peak flow readings started going in the right direction more quickly, so this was definitely the right decision for me.

I hadn’t heard that you could take a solely steroid inhaler as needed throughout the day. That seems like quite a high dose of steroids, but I am no expert! I had a similar situation recently where I was absolutely convinced that my GP said to take my blue salbutamol inhaler 2 puffs 4x a day, but I spoke to the asthma + lung charity helpline and the nurse said this is quite unusual and for me to check. I called the GP practice and the admin person I spoke to said the prescription was for UP TO 4 times a day. I’m a veterinary nurse, so I know that even the most sensible person can sometimes get the wrong end of the stick and give an accidental overdose or give medication incorrectly; for this reason I am an advocate for writing everything down in a plan for the client to have and check. I have never received a hard copy ‘asthma plan’, so I really feel like my medication protocol is based on my memory and a generic hastily-applied prescription label!

I found the asthma + lung helpline really useful. If you’re unable to send a message to your GP to confirm how you’re meant to be using the Qvar, maybe give them a call for advice?

Rightly or wrongly, I take a peak flow reading morning and evening and log it on the Health app on my phone (I have an iPhone). It’s a really good way to have an objective view of how well-controlled your asthma is I think. I was prescribed Montelukast, and as it wasn’t on repeat I thought it was just a short course. I didn’t subjectively feel like it helped, but the peak flow readings told a different story, and adding it back in to my protocol helped my readings go up a bit again.

Good luck!

[nmcv13 in reply to MarmiteMalice]

Hi! Sorry to hear you have asthma too, late onset seems to be a thing that you only hear about when it happens to you and you go looking for answers! It’s a long road to understanding what triggers you and how to best manage it. Mine got really bad around 55 years and stepping away from full time work has greatly improved my symptoms.

My asthma management plan is written down and I have to continue with fostair, ventolin 4 hrly and Qvar 100 12 puffs twice a day. The pharmacist said the dose of Qvar has to be 3 times the dose of steroid in Fostair. Hopefully the Qvar will work it’s magic and I won’t need steroids!

[Pipsqueak77 in reply to nmcv13]

Hi nmcv13

I take Qvar alongside Relvar, however this is prescribed by my tertiary cons. It is also only 2x doses twice daily if needed.

12 puffs x2 times a day of Qvar 100 alongside Fostair 200 seems a massive amount of steroid to me (although I’m not a medic).

Please check these doses with your GP or hospital team asap as I really feel there has been a mix up here somewhere.

Hope you get better control soon..🤞👍😊

[Pipsqueak77 in reply to Pipsqueak77]

Sorry… should also say that at this point maybe you should be looking at pred to sort your exacerbation and dampen the inflammation more quickly..?🤷‍♂️

😊

[nmcv13 in reply to Pipsqueak77]

Thank you, I think I’ll check with asthma uk first the pharmacist - but I am much improved on this and I am keen to not take oral steroids unless really necessary.

[Melanie1989 in reply to nmcv13]

Hi nmcv13 who prescribed you this dose? Please do check this dose with a health professional as this is an extremely concerning dosage and is not licenced. There are a list of adverse side effects this could cause. If this was prescribed it should only be by a hospital consultant with clear justification.

Unfortunately a lot of health professionals can become confused with asthma and can often give well meaning but wrong advice. Hope things are sorted for you soon.

[nmcv13 in reply to Melanie1989]

The pharmacist at my GP surgery and it has been reissued twice. It’s written in my asthma plan. I’ve looked up the NICE Asthma guidelines and found the above. I think the 12 puffs of Qvar plus my normal fostair equals 4 x my normal dose. I am going to follow this and do it for 7 days as I am much improved. It’s also much less steroid than an oral dose of 40mgs per day for 5 days.

.

[Melanie1989 in reply to nmcv13]

Hi I appreciate that this is what the pharmacist has issued and this is helping you; however I would still encourage you to seek a second opinion.. I would definitely give asthma uk a ring on Monday.. As a nurse I have seen some shocking prescriptions..

The guidelines of increasing ics is going from 1-2 puffs or occasionally 3 twice a day.. The only exception being a MART regime, which qvar isn't licenced for and 12 puffs would be a 999 situation.. There are far more safer alternatives and treatment plans your pharmacist could have explored. However as always the decision is yours, I just wanted to make sure you were fully aware..

[Showgem in reply to nmcv13]

As others have said, if you’re struggling so much with your asthma that you need to take 10 x Qvar a day, every day, you need to see your doctor asap. The information the pharmacist has given you doesn’t sound quite right for continuous use.

[Tree20862]

My pulmonologist has me finish the cannister of my rescue Asmanex. They lose their efficacy if they sit open too long so if I start it for a flare, I stay on it until it is gone.

[Tree20862]

I also agree that 12 puffs seems like a lot. Clarify with your doctor.

[Merryroundabout]

Are you sure it’s 12 puffs of Qvar twice a day? It’s very unusual and could be a misreading or typo that should be “1-2 puffs twice a day”. I can understand the reason for adding it onto your Fostair as Qvar is good at getting right into the smaller spaces in the lung but that dose is massive.

[Jollygood in reply to Merryroundabout]

Good point re the typo. 1-2 puffs sounds much more likely.

[Merryroundabout in reply to Jollygood]

I’ve actually had that happen with one of my mum’s medications - I queried why her 400mg dose was reduced to 100mg and that was a misreading error.

[DollyDutchGirl]

nmvc13 - please, please check with your GP/Asthma Nurse re the correct dosage for you. Like others, I’m inclined towards it being 1-2 puffs twice a day and not 12 puffs twice a day. I know that certain medications can be prescribed ‘off piste’ - as I have Fostair 200 prescribed as MART - (meaning I can have 2 puffs am and pm plus, up to four extra puffs as needed) - which isn’t usually recommended for Fostair 200.

However Quvars leaflet states; ‘Adults and children 12 years of age and older—At first, one to two puffs two times a day. Each puff contains 40 or 80 micrograms (mcg) of beclomethasone. Your doctor may increase your dose as needed. However, the dose is usually not more than 320 mcg two times a day.’

In Quvar100 - each puff contains 40 mcg of beclomethasone. Therefore, if you are actually taking 12 puffs - you are taking 480 mcg instead of 80 mcg. If you are taking 12 puffs twice a day, you are taking 960 mcg daily instead of 160mcg.

The NHS website sates; ‘If your beclometasone inhaler also contains formoterol, you may be advised to use it as a preventer and also as a reliever for asthma when you're wheezy or tight chested. In this case, doses can be up to 8 puffs a day in total. Let your doctor or nurse know if you feel you need to use more than 8 puffs in a day.

Also - if it was felt you needed more inhalations than the Quvar 100 usual dosage - surely, it would be safer for your doctor change you to Quvar 200…?? Please, please double check with your GP what dosage you should actually be taking - if only to put our minds at rest. 🥴x

[nmcv13 in reply to DollyDutchGirl]

Hi all, thanks for all your comments. I have checked with asthma.org.uk and have just now spoken to my Dr. Firstly it was definitely 12 puffs twice a day as I was told this and it was written down BUT it was an error. Both the nurse from asthma.org.uk and my Dr confirmed this should not have been prescribed. The asthma.org.uk nurse said I was taking the equivalent of 5000 mcg of inhaled steroid when taking both which would only ever be prescribed by a Consultant. So my Dr is arranging a face to face asthma review with the practice nurse, and a FeNO test. He also prescribed omeprazole and Gaviscon for a month to see if I have silent reflux. I am so glad I asked this question and have resolved this issue! Thanks again.

[DollyDutchGirl]

I am so pleased that you have got the issue resolved - and that your doctor is arranging a face to face appointment with the practice nurse. Asthma U.K. are excellent at helping to clear up queries - and put people’s minds at rest. Omeprazole is often an excellent addition to the armoury of an asthmatic, as silent reflux can definitely be an issue.