Pink vs Blue inhaler

[mrsm49]

So at my last asthma check couple weeks ago i was advised that new research showed the blue inhaler to cause lung damage in the long term and that i should use my pink fostair as a reliever. I had been told that before so as I was needing to use the blue inhaler as i had that chest infection going round I did try the pink as a reliever but it wasn't as effective as the blue one. The asthma nurse said that wasn't possible and he'd never heard that before, has anyone else found same as me??Also as a last note he added my pink inhaler was being changed to powder version that you don't use a Spacer for as it's more environmentally friendly. Assume this is happening everywhere, any thoughts people?

[Troilus]

I have Fostair 200/6 as my preventer inhaler and a Fostair 100/6 which I use in addition when my peak flow starts to drop - I add in extra doses and will have a puff of that if I’m getting out of breath more easily than usual, if that makes sense. I still have my blue inhaler which I take in the event of an attack or when I’m struggling. Since using the 100/6 I have used a lot less of the blue than I used to.

I have tried the powder inhalers, which were fine when I was fine. The difficulty was when I needed them most I didn’t have the lung power to inhale them properly and it seemed that I ended up with most of it ( or at least that is how it felt) sitting on my tongue. I was changed back, which is much better for me because it means I can use the spacer and when I’m “ in trouble” I can use the tidal method of inhalation.

Hope this helps.

[mrsm49 in reply to Troilus]

Thank you, I was concerned about not using the Spacer as I found my asthma improved greatly when I started using it and I don't need blue one except in rare occasions.

[Loveducks in reply to Troilus]

Hi, sorry jumping in on this conversation, I am steroid dependent and been switched from Flutiform to Fostair. I haven't touched it yet as I'm a bit worried about the depression aspect. I was taken off Flutiform as I realised this was causing mood issues but have been told Flutiform and Fostair are practically the same ingredients. Did you experience any mood changes when you started Fostair?

Thank you for help x

[gemwatercolour in reply to Loveducks]

Hi Loveducks. I’ve been using Fostair 200/6 MDI plus spacer since Feb last year and haven’t noticed any adverse effects on moods at all. FlutiForm is fluticasone and formoterol (well, fluticasone propionate and formoterol fumarate) and Fostair contains beclometasone and formoterol. I don’t suppose you know which of the two components in FlutiForm are associated with mood changes? A quick google suggests it is the steroid component, in which case, because the steroid is different in Fostair, swapping may help? I must stress though, I’m not a medic, and this is probably a question better answered by your GP!

[Loveducks in reply to gemwatercolour]

Hi gemwatercolour

Thank you so much for replying. Good point you made actually, so logical and why I didn’t think of that in the first place but sometimes when you have a lot going on you don’t think, which is why I’m so glad of this site. I’m going to do some research on it but also give it a go as I have no reliever now and been trying to reduce the steroids.

So thank you again and wishing you a Happy New Year x

[gemwatercolour in reply to Loveducks]

Hope it’s working out for you and Happy New Year to you too! x

[Homely2 Administrator]

Switching to a dry powder inhaler was raised by my asthma nurse, she said that when my asthma was under control, and if I agreed, they would look at changing me to a dry powderinhaler. Since my asthma is never under control, this is on a back burner.

I would give the switch a go, but go back to them if it does not work. Asthma care is meant to be managed with the patients consent.

Re using the pink inhaler instead of blue, I presume you are now on fostair 100 mart. I like being on the mart programme as it has reduced my use of the blue inhaler, which makes the blue inhaler more effective for me, so a win win.

Using the pink inhaler, helps prevent the second and third asthma attack, in a way that the blue does not. However for me, in a nasty attack I still need the blue inhaler, as like you in the short term I find it more effective than the pink inhaler.

I would have a chat with the helpline on 0300 2225800, re how fostair 100 mart works and the benefits of it.

I used to be on fostair 200 and loads of blue, I am much happier on fostair 100 mart and less blue.

[mrsm49 in reply to Homely2]

Thank you, like you I rarely need blue inhaler now but it deff worked better when my chest infection kicked it off and I only used it few times over a few days. The pink one deff did not give me the quick relief the blue one does. I will phone that no thank you x

[Patk1]

A pharmacist at large hospital told me fostair does contain a bronchodilater,but only in small quantity so u may need ventolin at times too.it will help reduce inflammation + reduce need for ventolin.yr entitled to have the drugs+ formation that works best 4u x

[Lysistrata Administrator Community Ambassador]

The MART (maintenance and reliever therapy) with either Fostair or Symbicort can work well for some people but it isn't for everyone. Sometimes you need the blue reliever!

I'm not familiar with the research on whether the reliever inhaler (salbutamol/Ventolin) damages your lungs - but I do know that poorly controlled asthma can damage your lungs. I wonder how much of the 'damage' observed from frequent use of the blue inhaler is actually from poorly controlled asthma, since people who aren't well controlled will be using it more.

The idea with lower carbon inhalers is to try them and see if they work, but the first priority should be what works for the patient and their asthma. No one should be forced to use a lower carbon inhaler just for environmental reasons if it's not helping them to control their asthma properly, but I don't know if this message always gets through.

I've also read that the biggest contributor to carbon emissions is actually Ventolin spray (MDI, metered dose inhaler). The best way to cut use of that down is by helping people control their asthma, however that needs to happen - but NOT by just telling people not to use Ventolin MDI.

Give the lower carbon one a go but if it doesn't work for you after you've given it a try then ask to change back. This page may help, but it's worth remembering it talks about people overall, not your individual asthma: asthmaandlung.org.uk/condit...

Some people prefer dry powder inhalers, but not everyone does and it can depend on the inhaler (I get on fine with the dry powder Fostair Nexthaler and I have severe asthma, but I found Symbicort hard to use when my breathing was worse, and I've never got on with dry powder Ventolin).

I also agree that you should call the nurses and chat this through if you're not sure: 0300 2225800 Monday-Friday 0915-5pm

[peege]

Hi, no way would I allow my Fostair MART 100/6 inhaler to be changed to a powder version. It's my understanding that only the MDI (spray type) cand be used in the MART regime (happy to be corrected). The MART method suits me very well being able to use less or more as needs change and I can use up to 8 puffs of it per day although my max has been 4 during winter plus a puff lasts 12 hours as apposed to Ventolin's 5 hours relief. I hardly ever need ventolin only during extreme exacerbation or infection.

Powders always gave me thrush despite rinse and gargle and not enough breath power to suck it down.

I realise were all different though and it's one'sindividual asthma needs that have to be taken into account.

[Poobah]

Everyone is different when it comes to inhalers and it's trial and error that will establish what delivers the best treatment for you.

I was diagnosed with an intolerance to the inhaler propellant over 40 years ago and this meant I had no option but to use dry powder inhalers. They transformed my asthma and after years of emergency admissions and life threatening attacks, I was able to enjoy life without the constant fear that a sneeze or cough would kick off another attack and visit to hospital.

As for being able to inhale sufficient dry powder medication, if a chest infection or virus is making this difficult, then taking a dose of Ventolin first and waiting 20 minutes will make all the difference. One of my more enlightened consultants taught me this some years ago. But for every day use, technique is king to ensure delivery of the medication. Even after all these years I have to focus on my technique every time, otherwise the medication ends up in my mouth.

So Ventolin continues to be part of my regime and I use up to 2 Ventolin Accuhalers a year; that's a total of 120 inhalations at most in a period of 12 months.

I agree with Lysistrata, in that badly controlled asthma is damaging to the lungs and Ventolin continues to play a part as reliever, when necessary. It's a good indicator for how well a patient's asthma is controlled and a good asthma plan will indicate how and when to use Ventolin and when to seek additional treatment or emergency treatment.

Leicester University has done research into the over use of Ventolin on lung cells and that research did indicate that lung cells may produce chemicals that make asthma worse if too much Ventolin is taken over a long period BUT they were looking at over use of Ventolin and used lung cells rather than patients. The upshot is, no one should be over dependent on Ventolin as their main asthma treatment, but it does mean that it will continue to play an important role along side the regular preventer treatments as part of an asthma treatment plan.

Dry powder inhalers probably won't suit those with a lactose intolerance, whereas, metered dose inhalers contain propellants and occasionally alcohol, which some patients may have an intolerance to. And with any type of inhaler, practice makes perfect.

[Lysistrata Administrator Community Ambassador in reply to Poobah]

Hi Poobah - generally agree but I used to get into a spiral with Symbicort when I was struggling with my asthma for whatever reason (not just colds and viruses) - even when I was using Ventolin before. I don't even know why I was struggling as apparently it's not the hardest to inhale in terms of strength. I've been involved in a study which compares inhalation strength and discussed this issue, and they said it could be individual and inhalation force isn't the only factor. And my technique was ok in general, but it just wasn't getting in for whatever reason - it took me a bit of time to notice as Symbicort definitely was helping before.

I don't have this issue with Nexthaler at all, 7 years into using it. It seems easier to take and I have to actually tone my inhalation down a bit lol. It is also fine particle which probably helps, but I just find the overall design easier to use. I guess what I'm saying is that people should definitely give it a try if things don't seem to be working with an inhaler, but sometimes another one will just work better and be easier to take for whatever reason - even if it's just easier technique wise. And that may even be another dry powder one!

[Poobah in reply to Lysistrata]

Totally agree. I found Fostair NEXThaler so much better than Symbicort DPI, and the difference in design, as well as the smaller particles have probably played a part for me.

I started on spin inhalers and found them very easy to use. Disc inhalers came next and they too were easy to use. Accuhalers were then introduced but the design doesn't seem to work as well in terms of being able to get a full inhalation. But they were expensive and no doubt good for the manufacturer.

A short stint on Serevent long acting bronchodilator caused me lots of problems, so I was quite skeptical when the combination inhalers were introduced a few years later. Symbicort never really met my needs and the Prof was resistant to me trying anything else. It was my asthma nurse who changed me to Fostair NEXThaler and the difference was palpable from the first day.

Accuhalers are far from easy to use, in terms of a full inhalation. The NEXThaler design is superior to the Symbicort design. But given the choice, I would go back to the spin inhalers or the disc inhalers, as there's nothing preventing a full, long inhalation.

[Billbo911]

The powder version has been around for a good few years now and changing it is nothing to do with the environment, it's about cost - a cheaper substitute for fostair- refuse it ! Tell them anything ie you just can't get away with it, it's causing mouth ulcers, which it will because being a powder it sticks to your mouth and you lose half the benefit anyway. Be prepared to fight for the original Fostair -I'm still on it now as are millions of others. Your health comes before cost and a GP practice that's trying to save a few ££. Good luck

[Poobah in reply to Billbo911]

FostairNext dry powder inhalers are more expensive then the Fostair MDIs, so definitely not an issue of cost in this case. Same with Ventolin. The DP Ventolin Accuhaler works out more expensive per dose than the MDI.

You maybe thinking of the generic versions of inhalers, but there is no generic version of dry powder Fostair.

[Tiggertheterrier]

that's really interesting. I have bronchiectasis on top of my asthma, so for me the blue inhaler ( Ventolin in my case) is absolutely essential! At the moment both conditions have been deteriorating over the last 18 months, my GP says I am maxed out on what they can prescribe. Sitting on a scandalously long waiting list to go back to respiratory consultant ( 15 months and counting......) and doing my best to manage it myself. Been waiting to be seen by RespRespiratory physio since September 2022, ditto Pulmonary Rehab. It just makes me slightly panicky thinking that all this time while waiting to be seen I could be doing yet more damage to my poor lungs by needing so much Ventolin just to get through each day!!

[mrsm49 in reply to Tiggertheterrier]

Try not to worry too much, research is a strange thing. I don't know about this particular research but sometimes when you look into it, the nhs makes decisions from a research project with a laughingly small sample size (I've looked into many thyroid research papers) it really beggars belief at times. Also while it may not the the case this time and it may well be an environmental decision as was said to me, many other decisions are cost related. eg cheaper prescription tablets often with more fillers (my mum reacts badly to many fillers bless her and is having increasing problems getting her prescription meds) BUT at the end of the day we should be very grateful and feel lucky that we still have the albeit struggling NHS , I hve rellies in the US so hear all about their awful have and have not health system. I hope that you get seen soon Tigger, good luck xx

[Tiggertheterrier in reply to mrsm49]

thanks mrsm49, trying not to panic is really hard sometimes! My surgery have been great, bless them, often functioning only with locums, in an old building that leaks like a sieve, but battling on. They have chased up my referral 3 times in writing ffor me. Doesn't help that our local heath board have been placed in "special measures" and CEOs come and go every few months. They were fantastic when my husband needed end of life care in September, can't thank them enough ffor what they did for him.

the nurses on his ward used to say they could understand the long waiting lists - 'if we physically don't have enough Registrars and Consultants we just can't run enough clinics to satisfy increasing demand'.

[berylmcgowan1]

hi

I was given the pink (FOSTAIR) inhaler to be used through a space haler and a blue salmol inhaler as a reliever to take the place of ventolin. I was told the FOSTAIR would also be a reliever if needed.

The FOSTAIR does not seem to relieve me when I’m breathless, the salamol helps a little but is not anywhere near as good a reliever as Ventolin.

I am going to ask my GP to prescribe ventolin again ( I was on it for over 30 years) but I think GP will be reluctant as apparently the normal ventolin inhalers are bad for the planet ! Never heard in all the time of using ventolin that it caused lung problems ? My asthma used to be very well controlled but over the last 12 months it’s unpredictable. I’d like to go back to the old meds.Hope you get sorted out and feel better soon.

[Gwalltarian in reply to berylmcgowan1]

The Ventolin evohaler uses exactly the same propellant as Salamol - it’s as kind to the planet - but in addition it does not have the ethanol that is in Salamol inhalers.

[CDPO16]

I was told years ago both my respiratory nurse and pulmonary rehab to use ventolin prior to my fostair to open up the airways so that the fostair was more effective. I also have braltus daily which is a powder and I now find that I rarely have the lung power to adequately inhale it. Conversely my ventolin and fostair are mdi and can be used with a spacer effectively.

[mrsm49 in reply to CDPO16]

I told the asthma nurse the powder sounded harder to use and wouldn't it increase incidents of thrush, he said no but I doubt him lol

[CDPO16 in reply to mrsm49]

I think that part of the problem is that those who advise us aren't users of these meds!

[mrsm49 in reply to CDPO16]

I think yr right x

[Merryroundabout in reply to CDPO16]

I spoke to the Asthma Lung helpline on Tuesday (re stepping down my steroid inhaler and Ventolin use after stepping up for a chest infection) and I asked if it’s helpful to take the Ventolin first to increase lung access for the steroid. The nurse said no, said that’s very “old school” thinking and there’s no research anywhere that shows it makes any difference to steroid take-up.

[CDPO16 in reply to Merryroundabout]

That's interesting. I wonder if that advise is still being given

[watergazer]

hi. I haven’t read all the posts however I use fostairnexthaler which is powder and it suits me very well. I gargle after taking it I have the blue reliever and only use that when extremely necessary. I was told to double my fostairnexthaler when I had a flare up Hope this information may help x

[BigBawsTam]

I have COPD and use a pink inhaler - 4 puffs a day with 2 in morning and 2 in evening. I have a blue inhaler as "reliever" but seldom use it. I've never had a powder inhaler. So it's total opposite to you, but it works for me. I have no clear idea what the difference between asthma and COPD is.

[Superzob]

Unfortunately, there is no "one size fits all" solution to this. I use a powder inhaler because I react to the aerosol in other preventers (though I'm OK with Ventolin); the reverse is true for other people. Although my preventer (Symbicort) can be used for the MART system (ie, as a reliever) I don't find it effective and use Ventolin instead. I'm afraid it's trial and error to find the most effective combination for any individual; as my GP says "asthma is big business" which is why there are so many alternative inhalers around.

[Hawkwell1994]

This is the same for me. I feel the blue is much better then the pink and don’t feel like the pink does anything to help

[Poobah in reply to Hawkwell1994]

They do two different jobs. The blue inhaler is a short acting bronchodilator and helps very quickly but for a maximum of 4 hours. The pink inhaler contains 2 medicines, one of which is a steroid which acts as a preventer over time, but has to be taken regularly in order to work and can take 8 weeks to build up to full effectiveness. The other medicine in the pink inhaler is a long acting bronchodilator that works for up to 12 hours. Relying only or mainly on the blue inhaler is not recommended.

If you're taking your pink inhaler as prescribed, but still relying on your blue inhaler more than twice a week, then you should seek an asthma review with your GP or asthma nurse.

[mrsm49 in reply to Poobah]

Yes for me the pink works very well except maybe few times year when I've caught a bug or hadn't been able to avoid one of my worse triggers (cigarette/fireplace smoke, heavy car exhaust and the molten tar smell when resurfacing roads a nice collection lol) Then I have tried the pink as a relieveras requested but the blue is definitely far more effective so I wouldn't be happy to not have a blue to hand as its scary not being able to breathe properly. Thanks for your help, I will try the powder versions (coming nxt prescription) but if I don't feel they are working as well i will insist on going back to what works for me x

[Poobah in reply to mrsm49]

I wish I had been more proactive in the past about saying "this isn't working well for me". My insistence in keeping my Ventolin has worked well for me and thanks to Fostair NEXThaler, I rarely have to use Ventolin now, but it makes all the difference when I get a virus or a chest infection or if something else triggers my asthma.

Good luck on the dry powder inhalers. 🤞

[Whiteclouds]

hello I’m shocked to hear that you have been told that the blue inhaler : salamol/ventolin damages the lungs I have had many asthma reviews and not once has anyone told me this nor have they told me to frequently use fostair when I was prescribed it. I am now on Trimbow which is better since fostair did not help much, and still taking the blue inhaler as a reliever to open up the lungs when having difficulty grieving then follow with the fostair in my case the trimbow. I would make a telephone appointment and ask the doctor if what you have been told is true. Hope your health improves and your worries about your meds are resolved.

[Poobah in reply to Whiteclouds]

I think that the healthcare professional may have been referring to the possibility of using too much reliever inhaler can make things worse. The attached article explains the University of Leicester's findings; sciencedaily.com/releases/2...

This was back in 2010 and more research has subsequently been done on the way MAST cells in the lungs behave in asthmatics. Research continues. But the upshot was to recommend an asthma review if a patient was using their reliever inhaler more than 2 or 3 times a week. That advice continues to be promoted.

[Whiteclouds in reply to Poobah]

Thanks for the clarity