switching to relvar from pulmicort

[Lizziep25]

I am on Pulmicort 100 2 puffs twice a day my Asthma nurse has suggested that I change to relvar 184 to try and control the severe oral thrush I continually get, I’m a bit dubious as I rarely need to use a reliever and in the winter I am able to reduce the Pulmicort to 1 puff twice a day. Also I have a pacemaker and after reading the patient leaflet I’m concerned about the effects of using vilanterol. I have Sjorgrens so my asthma is dry I don’t have a productive cough my nose never runs I just have a tight chest and wheeze when it flares up I have hayfever and July and August seem to have the worst triggers as I live in rural farming area near the coast. Can anyone offer advice about changing inhaler.

[Mandevilla]

Have you rung the helpline? They would probably be the best people to ask.

[Africanleopard Verified User]

Hi Lizziep25

Seems like you need to ask for a referral to an asthma specialist. In my view this suggested switch will not solve your thrush problem because Relvar contains a very strong corticosteroid.

It all depends how bad your asthma is. If it’s controlled in pulmocort then an alternative inhaled steroid called ciclesonide ( Alvesco) May solve your problem - it doesn’t cause thrush because it is only activated to work when it reaches the lungs.

This inhaler is a pressurised (puffer) inhaler which you need to be taught how to use. You may need a spacer to make it easier to use.

If your asthma is uncontrolled, then you may need an extra drug and that is why I suggested you. Should ask your GP for a referral to a specialist because of the other problems you have.

Hope this helps.

[risabel59 in reply to Africanleopard]

Ciclesonide is brilliant. It solved my oral thrush problems. I use it with a spacer. I've been using it since 2010. I also have an add on dry powder inhaler (Anoro) with LABA and LAMA in it. The only issue with ciclesonide is sometimes getting hold of it. It can sometimes take my pharmacy over a week to get it, so I have to be careful to always have a back up inhaler, and remember to re-order prescriptions well in advance.

[Lizziep25 in reply to Africanleopard]

Hi thanks so much for your reply.

My asthma is usually very well controlled but for me August is a difficult month as living in the countryside it’s harvest time with barley and oil seed rape being combine harvested which kicks up clouds of dust and mould spores into the air.

I used to have a pressurised inhaler (clenil) and spacer so am familiar with the technique.

First time I have spoken to this asthma nurse as had to move surgery due to last Gp retiring and no one wanting to take surgery on, rural West Wales has major problem getting medical staff to work here so it’s no good asking for a referral to a specialist the wait is probably about two to three years. If you have to go to A&E here you are sat waiting for nearly 18 hrs.

So I think I’ll just have to put up with the Pulmicort and fluconazole capsules for thrush, I will ask my nurse about Ciclesonide but it may not be in her remit to prescribe. Thanks for the advice

Kind regards Lizzie

[Melanie1989]

I can see the logic of where she is going as relvar is one puff once a day therefore reducing how many times you need to inhale the steroid... However she has prescribed the high dose relvar which by the sounds of things probably isn't necessary and will be a large hit in one.. there is a lower dose version that (92/22) which may have been more appropriate.

You could always discuss a trial of a MART regime this would allow you more flexibility around steroid intake. Have you thought about an MDI with a spacer such as fostair? This may help get to your lungs rather than throat.. I'm sure you know, but always rinse your mouth out after using your inhaler.. Are you on Montelukast?

If you aren't happy, definitely go back and explain your concerns

[Lizziep25 in reply to Melanie1989]

Thanks for your reply I have tried Fostair and montelukast 2 years ago unfortunately I had a bad reaction to them,both of them can cause irregular heart beat which is what happened causing severe vomiting and heart block which resulted in having to have a pacemaker. Also I found Revlar took over an hour to relieve my tight chest and I experienced gastrointestinal pain it felt like I had an ulcer and heartburn with stomach cramps which didn’t go until late evening and the following morning I woke up really breathless with a tight chest possibly due to changing inhaler but not prepared to persevere due to gastro issues. Next day I googled revlar and found on a gov drug site that gastrointestinal pain is a common side effect and long term use of Revlar increases the risk of bone fractures and pneumonia.

[Patk1]

Gd advice already.id say ring helpline tomorrow.do u take antihistamines to help with allergic reaction?

[Lizziep25 in reply to Patk1]

Thanks for your reply unfortunately antihistamines are difficult to use when you have Sjorgrens syndrome as they exacerbate the dryness of your mucus membranes it’s not recommended for Sjorgrens sufferers to take them

[Tree20862]

I had better control of thrush when I started rinsing with mouthwash PRIOR to my inhalers AND after. Not just water.