Hi, following an asthma review prompted by an exacerbation I’ve been moved from fostair 200/6 x 2 twice a day to seretide 125 x 2 twice a day. Started 48 hrs ago and just had a horrible night with coughing @ midnight, 02.00 and 04.00 am. Chest doesn’t feel quite right now but not coughing much. PF normal for me. Also on montelukast and fexofenadine.
I’m wondering if I’ve been stepped down by quite a lot? Should I go back to fostair or keep trying seretide? Review & prescription change was carried out by HCA who had done a years course in asthma. She also did spirometer which showed well controlled asthma.
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nmcv13
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Personally I would ring asthma UK nurse to discuss on their helpline.
As I understood it they are ameant to reduce your dosage when you have achieved control over a period of time.
A one off clear test with a spirometer by itself does not seem to show settled control.
I switched from fostair 200 to fostair 100 mart, under fostair 100 mart I can take up to 8 doses a day, ie equivalent dose to fostair 200, but this is a maximum, my minimum dose is just 2 doses a day. This allows me to reduce my steroid dosage when I want to, but raise it again when needed.
I went the other way, Seritide high dose to Fostair low dose. They did try to put me onto non propellant inhalers but I refused as I've had them in the past and didn't get on with them. I was only changed because the Seritide was no longer working for me, As others have already said, double check with the helpline on here or ask to speak to a GP, as seems a bit odd to change something that was working.HCA seem to be doing a lot more things now, manual doplars were only ever done by nurses but now HCA does them. Blood pressure readings used to go to a GP/Nurse or pharmacist, but that's the HCA too. xx
Well done for finding out what training the HCA had!
A few observations:
The inhaled corticosteroid ( flixotide) in seretide is twice as strong as the beclometasone in Fostair. So they have slightly increased the dose of your inhaled corticosteroid. However - normal spirometry does NOT mean good asthma control . It just means that it was normal on the day - asthma fluctuates so a single measurement or a single asthma control test only tells you how you are st that time - not whether your overall asthma is controlled. The fact that you had an attack before changing your inhaler means that your asthma is poorly controlled.
The disadvantage of switching from Fostair to seretide is that Fostair is licenced for MART therapy where you can use the Fostair for relief instead of the blue inhaler- this is the so called AIR ( anti inflammatory reliever) therapy which is safer and more effective for preventing attacks - because you are taking extra antiinflamnatory corticosteroid when you need this to damp down the asthma inflammation.
So it all boils down to the reason for the HCAs decision. While a years asthma training sounds good - what did this involve and was the HCAs competence to manage uncontrolled asthma assessed!
What modifiable risk factor causing your poor asthma control was the basis for the change to Seretide. Was your inhaler technique checked and correct ( for Fostair and Seretide)? Were there any asthma triggers that could have been modified- eg were you using excess blue reliever which could trigger an attack, were you smoking, were you at a fireworks display etc
So I suggest ask to be seen by your GP perhaps with the HCA to establish the reason for the previous ( and this new) attack and if it’s not clear, then ask whether FOSTAIR MART ( with the lower dose Fostair, or one of the other licenced MART inhalers) would be a better option or whether a referral to a specialist is appropriate.
Also of course, use A&E if you have another attack when your surgery is closed, and have a discussion with one of the asthma nurses on the helpline.
I was on seretide for about 10 years and was changed to fostair could use this as a preventer and reliever. What a mess although asthma wasn't fully controlled on seretide the side effects of fostair was horrific. Was fine for a few months then tremors couldn't hold a cup nor cut food, insomnia and sweats. I think changing can cause coughing but settles. I'd go back if fostair better for you but it wasn't for me I will keep my seretide. We are all different.
I have been on Seretide most of my life? I then got switched to Fostair this year and gave it my best shot? I was told I wouldn't need my reliever Atrovent as much. However, I needed Atrovent more because I was coughing? Even within an hour of taking Fostair. Despite trying Fostair four times a day, it still didn't work for me? I am now back on Seretide and stable again.
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