max inhaler dose?

[Gymbearo]

Hi everyone. I saw the hospital respiratory team about a month ago, who said that it is ok to take 5 puffs rather than the suggested max 4 puffs Fostair 200/6, as a kind of last resort before prednisolone. I’ve taken a lot of steroids this year and am trying to reduce the number of courses. However, having phoned the surgery today, as my asthma has worsened and I’ve also lost my voice, a letter hasn’t yet been sent from the hospital, which led to a debate as to whether this was ok. Can I just ask if anyone else has been given similar advice. Also, is it just me, or do other people lose their voice when they have a flair? Thank you

[ReedB]

Hi, I was in a similar situation earlier this year and did take 5 x 200/6 for a couple of days but still needed prednisolone to calm the flare. I've found it best to use my salamol or Spiriva when my asthma is that bad, until the pred kicks in anyway. Whether or not you should do the same I'm not sure. It's quite a lot for the heart to deal with.

I often lose my voice in a flare too because my inhalers affect my voice.

[Poobah]

I've just had a virus which exacerbated my asthma. So in the morning I take Ventolin, wait 20 minutes, before I take my Fostair 200/6. I take an extra dose of Fostair half way through the day. At night I repeat the Ventolin/20 mins/ Fostair. So I take one additional dose of Fostair but add in Ventolin morning and night. Normally I take Ventolin about once a week, if necessary.

I did this for a few days while the virus was at its worse and avoided Prednisolone and antibiotics. I have an emergency pack of Pred and antibiotics in case I do need them and would keep my GP in the loop. It took about 3 weeks to feel OKish, but that's normal for me.

[hilary39]

It's a hard line to walk because I find when my asthma is deteriorating I often wish I'd started pred sooner. But I'm trying to take fewer courses too. I think I've had seven this year so far.

Do you do the SMART protocol too of using your controller inhaler like Symbicort or Advair a few times a day?

My voice gets patchy when my asthma is bad. My severe asthma specialist recently said most people with sevre asthmatics he sees have vocal cord dysfunction from years of inflammation.

Keep us posted.

[Gymbearo]

thank you so much for your thoughts. Although I’ve been asthmatic for most of my life it’s only really the past few years it’s got worse and it feels like a guessing game sometimes trying to work it all out. It’s so helpful to hear from those experiencing a similar thing and to know it’s not just me.

[Homely2 Administrator]

I get too breathless to speak in a flare.

My gp asthma nurse when I was on fostair 200 used to sometimes tell me to take an extra dose mid day.

I found that the fostair 200 in bad times did not last the day. I have done better on fostair 100 mart, with a bit of extra support from initially fostair 200 and now alvesco. So now I am on max six of fostair 100 and two of alvesco 130.

I still though do not have the cortisteroids right, with a couple of bad flares a day at present.

On the other hand my spiriva and salamol are superb.

[runcyclexcski]

Inhaled steroids are (said to be) far safer, in terms of microgram of steroid dose, than oral steroids, and they are applied locally (in the upper respiratory tract). Given the choice between oral and inhaled steroid (provided that the inhaler gives a relief) I would use the inhaler, even if at a higher dose. That said, if it's not working, it's time for preds.

[Superzob]

If you're ever concerned about exceeding the maximum dosage, refer to the British National Formulary at bnf.nice.org.uk/drugs/beclo.... Although 5 puffs exceeds the maintenance dose, Fostair can be used as part of the MART system for short-term relief, like you would use Salbutamol. Consequently, an extra puff of Fostair may be more effective and less burdensome than several puffs of Salbutamol.

[Gymbearo in reply to Superzob]

I Think it’s only the 100/6 that can be used in that way but I could well be wrong!

[Chip_y2kuk]

I'm allowed to take 6 puffs of the 200 fostair pmdi "in a pinch" ... but yes it's an off label/unlicensed dosage and the maximum any GP will *let* you take is 4 puffs (as its the maximum licenced dosage)

And beclomethasone is well tolerated up to 800mcg after that there is a massive increased risk of side effects.

[Gymbearo in reply to Chip_y2kuk]

Thank you!