medical practice changing my inhaler for no apparent reason

[Alf-T]

I have just received a text message from my medical practice to say they are changing my inhaler from Fostair to Luforbec as per NHSL guidelines don’t know what these guidelines are . I have been on Fostair for 10 years and my asthma has fairly well controlled I’m a bit concerned to make this change now , my doctor’s practice haven’t had an asthma nurse for three years so I don’t get a regular check up or someone to ask about this change . Anyone else on Luforbec ?

[SineadO]

Hi there, I am not on the other inhaler but one of the reasons may be the nhs net zero target and the aim to phase out cannister inhalers due to their large carbon footprint (there is a gp specific guideline on this as far as I know), they should provide you with information on this though and not just swap! You can call the asthma uk helpline they provide asthma nurses who are fantastic and do phone consultation

[SineadO in reply to SineadO]

Asthma uk helpline 0300 222 5800

[Mandevilla]

They shouldn't be changing your medication without at least explaining why!

I'd definitely want an explanation from them at the very least. But I agree with @SineadO that your best option is to call the helpline - they can advise on any potential problems with the change, how to approach your GP, what questions to ask etc.

[Melanie1989]

Hi, Luforbec is exactly the same as Fostair with the same ingredients. The reason for the change is Luforbec is half the price of Fostair. Fostair is slowly being phased out of Asthma formulary. The only difference is the canister on Luforbec does feel cheaper, however the only difference is the brand name. I hope this helps!

[Alf-T in reply to Melanie1989]

Thanks for all the replies I think I’ll contact asthma UK help line . Cheers

[BigBawsTam in reply to Melanie1989]

Melanie - I would disagree with you regarding "same ingredients". I got the same letter but I checked a FULL list of ALL ingredients on the manufacturers websites (instead of just following 'advice' of Health Boards who are motivated by saving cash and not only patient health). The ACTIVE ingredients may be the same, but not ALL are.

Ask yourself - If both are identical, how can one be much cheaper than other?

eg. cars have the same ACTIVE components - wheels tyres, engine, seats etc - but would you swap a Rolls Royce for a Mini?

[Melanie1989 in reply to BigBawsTam]

Yes, and it is the active ingredients that treat the asthma. Luforbec has the same "active ingredients" beclometasone and formoterol, the same fine particles. The original point of my reply was to say that it is not a completely different inhaler. It is a generic version. As with everything not everyone will agree with it, but it wouldn't of passed NICE , if it didn't produce a similar effect. If it doesn't agree, then I am sure any good asthma nurse will swap back to Fostair, however like I said before low dose Fostair is slowly being phased out, therefore I'm not sure how long it will be available for. Considering the cost of a Fostair is roughly £32.00 and Luforbec is around 14.00 I can understand why the NHS would want patients to try. In my area they use bibecfo, which is even cheaper than Luforbec.

Anyways my reply wasn't to get into arguments about brands vs generics, just to say the inhaler is a brand swap. If you don't get on with it ask to change back 😊

[Mandevilla in reply to Melanie1989]

It's important to specify the difference between 'all ingredients' and 'active ingredients'. If 'all ingredients' are the same, then changing between two different brands would have no impact on the patient's asthma and any worsening of symptoms would not be due to the medication (unless it were delivered in a form that was more difficult to inhale). But if it's only the 'active ingredients' that are the same, then it's possible for a person to have a reaction to one of the other (non-active) ingredients.

[Melanie1989 in reply to Mandevilla]

The only difference is the acid compounds which forms 0.024% of the inhaler and has no bearing on effectiveness or safety, which is shown on the gov website. I'm not taking away anyone's experience as if your asthma is worse on it then your asthma is worse. There is however not enough evidence to support this. Maybe that will change in the future My point of the post is to reassure the inhaler is a generic version of the one already prescribed, as I often think this is not made clear in the texts sent out as people often think they are getting a new inhaler entirely.

I understand people's point of view as I was recently changed from Ventolin to salamol, and the inhaler feels much cheaper. It does however work, is better for the environment and is cheaper.

As a very severe, unstable asthmatic on a biologic, I like to think that maybe some of that money saved can open up biologics to more people. Although I appreciate this is an idealistic view. As I stated earlier Fostair is slowly being removed from asthma formulary so there may not be a say soon!

[Mandevilla in reply to Melanie1989]

"I'm not taking away anyone's experience as if your asthma is worse on it then your asthma is worse."

That was the point I was trying to make. If someone thinks their inhaler is 'identical' to the one they were previously on, they could dismiss worsening symptoms as being in their imagination. Which is why it is important not to describe a medication as 'identical' when it isn't.

I've collapsed and lost consciousness due to an asthma trigger which was present 'in quantities too small to have any effect' (supposedly). Which I believed. Until circumstances made it clear that the quantity wasn't too small. (NB: Not referring to this inhaler in case anyone is worried!)

I'm all in favour of changing to cheaper inhalers - anything to save the NHS money. And differences in ingredients are not necessarily going to cause a problem. It's just important to be aware that it could be an issue for some.

[Gwalltarian in reply to Melanie1989]

Ventolin evohaler and salamol have exactly the same propellant but in addition Salamol has alcohol. Ventolin evo has no cfcs therefore is no worse for the environment than salamol.

[Melanie1989 in reply to Gwalltarian]

It's the propellant volume that is different, which is why Salamol can often feel like you are not getting anything when you are.

Ventolin is the equivalent in carbon footprint of driving a car 174 miles, where Salamol is equal to 74 miles. It is much more eco friendly, however eco friendly should never be at the expense of someone's asthma control.

[Gwalltarian in reply to Melanie1989]

👍

[Pontyp in reply to Melanie1989]

Just to say for info, - the main ingredients are the same but one of the acids is different on closer inspection, I pointed this out to my asthma nurse, she was unaware and changed me back to Fostair.

[Pip79510]

Hi,

I am on Fostair and got changed to Luforbec much the same way as you described. As I understand it, it is a cheaper version of Fostair. Most people are absolutely fine with it, but I used it for one week and because I am super sensitive to meds anyway I had a reaction. Like I say, I know loads of people who have changed and been fine if not in some cases better with it. But I wasn’t. Contacted my nurse and they changed it straight back to Fostair.

Good luck, and yeah just make sure to contact straight away if it is not right for you x

[BigBawsTam in reply to Pip79510]

Pip - That's almost the same as I done, but I didn't do a trial with Luforbec - I saw my GP and she kept me on Fostair.

[AmySm25 in reply to Pip79510]

I’m about to try and get moved back to fostair as I’ve been changed to luforbec and I can’t even take it without coughing. So frustrating

[Scrofulous]

I was changed over to Luforbec a few years ago. It works well in controlling my asthma along with Montelukast. However, I've had issues with it making me cough on inhalation unless I breathe it in ultra slowly, and getting two doses on one press of the canister, which happens now and again and which I can't inhale because it burns. I did go back on Fostair but couldn't tolerate the irritation it causes to my throat. The change is for financial reasons as Luforbec is made in India and much cheaper.

[AmySm25 in reply to Scrofulous]

That’s the issue I’m having!!

[Scrofulous in reply to AmySm25]

I think the cannister etc is cheap and nasty. At one point I put my Luforbec into a Fostair cannister I'd kept and it worked perfectly. If it wasn't for the awful throat irritation from Fostair, and the worry of serious consequences from constant throat clearing, I'd go back on it.

[Poorolddear]

Chances are the change is down to costs. Luforbec is considerably cheaper than Fostair. My own experience with Luforbec was very poor - brought on violent coughing attack each time I used it, even with a spacer device. Fortunately I use a pharmacy where the staff are very approachable and will listen when you explain your issues with medication and they have ensured that I receive Fostair. Try to speak to your GP if you have any problems and stand your ground - not easy I know. Good luck.

[BigBawsTam in reply to Poorolddear]

Well Done. From I've read on this forum and elsewhere, Fostair is a superior product and I got kept o9n it after a word with my GP. BTW I have COPD, not asthma - I should have mentioned this earlier. I don't know if that makes a difference.

[Poorolddear in reply to BigBawsTam]

Well done to you too, it's not easy getting a GP to accept that you are the one who knows your body best!!! I battled for years to convince medics that I suffer with asthma and do not have COPD. At one stage I was prescribed Anoro by my GP after I'd been seen by the local COPD team who said I didn't have COPD and discharged me. On reading the leaflet I saw that it was for COPD and should not be used for asthma. Well, I thought, the doctor must know best. A week later I was collapsed on the floor and finished up in A & E, where they advised me to stop the Anoro. Some time later I had two admissions to hospital with asthma attacks, saw a consultant who ordered blood tests for allergies and lo and behold, I suffer from allergic asthma - allergies to animal fur, tree pollen, fungi, all sorts. Since then I've had no major attacks and am on 2 puffs of Fostair morning and evening as a preventer and rarely use Ventolin.

[BigBawsTam in reply to Poorolddear]

Good for you. My Fostair doses are same as you. I also have a Ventolin inhaler, but only use it on rare occasions. I'm pleased to hear you are confident you are on the right treatment now. These admissions to hospital sound horrendous!

[BigBawsTam]

Alf - I am 70yrs old. I was on Fostair for 2yrs when I got same letter as you. I was happy with Fostair and surprised and ANNOYED that they (some anonymous person who sent the letter, unsigned, to me) had said they were changing me to Luforbec.

No good reason was given, cos they said ACTIVE ingredients were the same.

NB - Not ALL ingredients are EXACTLY the same! - as seen if you look carefully at ALL ingredients of both! I got this info. online myself when I checked the manufacturer's bumpfh.

The main (or ONLY) reason for the change is the COST. - Luforbec is cheaper!

I got an Appt. with GP. She confirmed the above and, cos I was unhappy, she rescinded the letter and left me on Fostair. You shouldn't meekly accept a cheaper alternative to Fostair, in my humble opinion!

[Pontyp]

Hi There, I had a letter from my GP surgery saying they were changing people from Fostair to Luforbec, - it’s down to cost, - I didn’t get on with Luforbec, it made my eyes slightly blurry when driving and some slight dizziness so I was changed back to Fostair!…They say Luforbec and Fostair are the same, but one of the acids is different on closer inspection,, if you don’t get on with Luforbec go back to your doctor/nurse and ask to go back to Fostair!!

[BigBawsTam in reply to Pontyp]

Yeah, I'm not surprised - I've yet to hear anyone speak in praise of Luforbec compared to Fostair. I dunno about the acids you mention, but I do know ALL ingredients are not the same. Your advice sounds good to me!

[fallon12]

Hi , I recently had my inhalers changed but it was because of a hospital stay and the doctors did discuss it with me 1st. I agreed to try it but my asthma got worse and I’ve now been told I cannot return to my old inhalers with out the hospital agreeing . Apparently my doctor can’t make that decision. Very weird. I’ve never had a problem before. Just to say I have returned to my old inhalers and after just 5 days I feel almost normal lol. I think they have to get your permission to change them or have that discussion so you know what’s being done with your health and care. I hope things go well for you. Good luck .

[Welshtoffee]

Same happened to me went to collect a repeat prescription of seretide and was shocked to find that it had been changed to fostair with no discussion or warning. As I couldn't get an appointment with the GP for a while and run out of seretide had no option but to take fostair. Had side effects from fostair and was changed back to seretide after the GP appointment. . As with others on the forum I googled the price of both inhalers and fostair was a lot cheaper.

[Myasthma1]

ive been on fostair for two years and don't rate it at all I reckon it's a placebo I'm on the 100/6 and think I need a stronger one cos I had a flu and it went to my chest it's so bad they've given me clarinthromycin now after wasting time with amoxil and a course of steroids