Dosages

[Homely2]

I have just been moved to 640 of alvesco and 800 of fostair 100 a day by my consultant.

What are the rules on dosages when combining different inhalers, can you just have the maximum dosage of each inhaler.

[risabel59]

Hi there Homely2,

This is an interesting question, and has variable answers according to your consultant. So in the past I have been up to 960 of Alvesco a day, + Seretide 500 + Spiriva. However current consultant takes a view that 640 of Alvesco a day is max inhaled steroid. Also no GP should prescibe that combination although lots of consultants do.

So I use 640 of Alvesco + separate combination inhaler with a LABA LAMA mix, no additional steroid. If they think I need more steroids its onto oral steroids. The reason being, (apparently according to current consultant) is that more inhaled steroid than the 640 of Alvesco is systemic anyway, so better to go straight to oral if not controlled.

However for me, I am now in a catch 22 situation, as I have been diagnosed with another condition called EDAC, (excessive dynamic airway collapse) (basically when I cough my large airway collapses so I don't move mucus). They think that this is possibly caused by steroid usage and asthma. I have used inhaled steroids for 50+ years, and had numerous OCS courses over the years. So now I am not allowed Oral steroids without blood tests and FeNo test. And here's the kicker, my gp doesn't have FeNo, so I have to be able to get hold of Tertiary Team to arrange this all while sick, rather than self managing at home!!!! (Can you hear the rant?)

The Tertiary team are being helpful in as much as they are trying to put together a "rescue kit" for me that doesn't necessarily involve steroids.

My view is that if it works for you then do it, or at least see if you can stabilise. But be aware that there seems to be some downside.

I'm very interested to hear other views on this, particularly as doctors don't seem to agree.

Best

R

[Gareth57 in reply to risabel59]

I think medics are suddenly aware of how the stuff we inhale affects us long term. About 20 years ago I had a gp who told me I couldn't take too much ventolin as it was incredibly safe having been rigorously tested, now you can only have 1 inhaler a month, my gp practice is now reluctant to give out oral steroids and antibiotics are like trying to find hens teeth but a few years ago the were offered like smarties.

[Homely2 Administrator in reply to risabel59]

R

Thank you for your reply.

Your present consultant just says exactly the opposite to mine. I, at the instigation of my GP asthma nurse, raised the point about going on oral steroids instead of having max fostair as well as max alvesco.

He promised to set out his reasoning for my GP asthma nurse, in a letter, basically he says that oral steroids will be much worse for me.

My consultant though had my file reviewed by the local tertiary centre before seeing me, and has said he will now have it reviewed again, which I like.

I sympathise with you re the feno, how are you meant to get hospital for a feno and blood test. I certainly am unsafe driving, when my asthma is out of control.

Homely

[Patk1]

I've been on 640 alvesco for many years alongside fostair,px by consultant It's worth trying x

[Homely2 Administrator in reply to Patk1]

Do you use your spacer with the alvesco.

[Patk1 in reply to Homely2]

No as its a round mouthpiece x

[Melanie1989 in reply to Patk1]

Alvesco fits into a standard spacer, and should always be used . It looks like it won't fit but does and is compatible 😊

[Patk1]

I've tried but it's not an option for me, fit is too tight.square peg,round hole springs to mind