Switched from Seretide 250 to Fostair 100/6

[Dixiegirlphyl]

Morning all, I had been taking Seretide 250 for sometime and it has been, I believe, controlling my asthma well. I have Ventalin as a reliever which I use as and when needed.

Had a bad cough develop in early May which I didn’t think was related to my asthma but did caused major sleep issues. Drs checked chest and lungs were clear so told it would just take its time to clear.

On return from holiday at end of May still coughing and went to drs again. During this visit the dr suggested I switch to Fostair 100/6 - 2xpuffs twice daily. Also mentioned might be worth considering stopping Montelukast, also been on for several years, at some time in the near future.

I now feel the initial cough has subsided and not causing the issues as before but my asthma is getting much worse; chesty, bit wheezy, tight cough and annoying. I know we’re now experiencing hayfever ( take Loratadine) as we’ve now got some much needed sun too but not sure what to do.

I suppose my question to you all is : is Fostair 100/6 equivalent to Seretide 250 and have I given it sufficienct time to ‘bed in’ from 5 June til now? Or should go back to dr and probably see yet another different one to get their take on what to do?

[Darceydoo]

Hi there

I was on Seratide 250 and did well on it. Then I was changed to Fostair initially ok but after 3 weeks the long acting Formeterol was only lasting 8hrs instead of the 12.

So I insisted on Seratide again.

Initially its quick acting but with me it wore off too quick.

[Dixiegirlphyl in reply to Darceydoo]

Thank you Darcydoo, the fact that the pollen& hay fever has gone through the roof during the switch will not have helped either!

[peege]

Hi, a new inhaler can take up to 8 weeks to become fully effective regardless of beingon other inhalers. If you're on the MDI (spray type) Fostair 100 you can take up to 8 puffs daily on the MART regime/method. So if you're prescribed 2 puffs morning and night then you have an extra 4 puffs to take in between which I found very useful when adjusting to it.

I must say I've found Fostair 100/6 utterly brilliant and very rarely need extra puffs or ventolin since being on it. The particles are finer.

I would hang on to the 8 week mark. Check your Fostair inhaler technique (manufacturer's website &/youtube). If using a spacer (essential with spray type MDI) check that technique as well.

NB I don't know anything about the powder Fostair (I cannot stand them personally)

The pollen has been particularly awful & berserk this year after a late start & all the wet and if you've recently had a virus it can really set you back.

You could always call the helpline for advice 0300 222 5800 uk office hours. Good luck, P

PS there are 'Related Posts' to the right (or scroll down on a phone I think) with posts & replies on the same subject to check out

[Dixiegirlphyl in reply to peege]

Thank you Peege, I’d like to hang on in as I’ve read the benefit of not taking Seretide (thinning skin) are good.

[peege in reply to Dixiegirlphyl]

I'm glad you'll hang on. It's worth it if you can. I didn't mention my skin as I thought I'd waffled on enough. On Seretide 100 2 puffs am & pm ( 2 puffs of 250 am & pm in winter time). My skin was absolutely dreadful, it ripped at the slightest knock for years I'm covered in scars. Around one rip i had 22 stitches in hospital. I took to using Steristrips 6mm to stick back the rips and carrying packs of them in every bag first aid boxes, sponge bag & at my family's homes. I wore double tubigrip on both forearms for protection. Another horrible thing was that every tiny scratch on throat soft tissue resulted in a blood blister of varying sizes. One was golf ball size blocking the airway. My poor adult son had to stab it with a fork. Nightmare (at a posh dinner introducing me to his French future in-laws) we pretended i choked on a fishbone when in fact it was a tiny stab from a fishbone 🙄. The blood shot all over their bathroom. I can laugh now.I thought that was my life for the foreseeable however, within 3 months of being on Fostair all the above completely gone. I've just a good few scars I make sure to put sun block on .

On seeing my arms once a GP took my hand and offered to refer me fir psychological assessment, it was a struggle to make her believe it was the flipping Seretide not me self harming ffs. Three different respiratory nurses also told me on no account was there enough steroid in inhalers to cause thinning skin. (I don't trust them anymore).

Anyway enough of me waffling, I really do hope it works for you we are all different though. Good luck

[JumpJiving in reply to peege]

peege

The skin tearing problem is something that is common when people are taking oral steroids such as hydrocortisone or prednisolone long-term. It seems likely that the dose of Seretide that you were on was actually resulting in too much absorption into the bloodstream rather than just helping the lungs. You were probably heading towards adrenal insufficiency, switching to Fostair (which is less potent) when you did may have saved you from what is a horrible condition to have.

When on Seretide 250, you should have been given a steroid card to carry with you at all times - had you been in an accident and ended up in hospital, if they didn't know you were on Seretide 250 and you didn't get any, the danger is that you could end up in potentially fatal, adrenal crisis (something A&E departments are notoriously bad at diagnosing and treating).

Although Fostair is safer in this respect, you might want to ask your GP to do a 8-9am cortisol blood test once or twice per year as part of monitoring your asthma meds going forward.

[peege in reply to JumpJiving]

Thank you, I only ever used the Seretide 250 during a couple of winters and even then not all the time by any means. I was always supplied with the low dose one, one puff am & pm during summer was adequate, two puffs am & pm from December to Spring ie when the temperatures/ humidity were changeable. My asthma nurse at the time gave me the 250 to use if necessary during winter instead of the lower dose (cant remember if lower one was 100 or 150), definitely didn't use the 250 regularly. Skin was very bad on the lower dose on only. I've always carried a blue steroid card. Only on two occasions have I agreed to take steroid tablets in my life, I utterly hate them & the night palpitations they caused. I took to taking them at 5am which wasn't so bad the following night.

Interestingly, for the 6 or so years I've noticed my stress levels shooting up exponentially for little reason so have been concerned about cortisol levels, unlike the extremely calm person I've always been. I will definitely ask for the morning cortisol blood test next time I manage to get an appointment .

Thanks again for the advice JumpJiving (great name)!

Edit: I have CFS, I wonder if that's due to adrenals 🤔

[JumpJiving in reply to peege]

Low cortisol does result in extreme fatigue, and messes with handling stress, so definitely worth checking

[peege in reply to JumpJiving]

Ah, thanks....I'll be devastated if this turns out to be the cause of the extreme fatigue after it ruining my life for so many years. Grrrr I don't think cortisol was tested during all the blood tests pre dx for CFS in 2016

Incidentally I was treated by Dr Barry Peatfield many years ago for low thyroid but nhs gp saying my levels are normal (odd when two sisters plus mum are on thyroxine ).

I'm going to have to scrape the bottom of the barrel for some energy to get to a gp.

[JumpJiving in reply to peege]

I know how you feel - I used to have some great GPs, but they’ve retired and I really don’t get on with my current one - try to avoid contact whenever possible.

Always get the actual blood test results, particularly for anything endocrine such as thyroid and adrenals, rather than accepting words such as normal or pass. Being inside the reference range for TSH , FT4 or FT3 does not mean you are well. Similarly, for cortisol, there are different reference ranges for 8-9am and the whole day, as cortisol drops as the day goes on (that’s the simplified description ) - doctors often mistakenly say a 8-9am result is normal because it’s within the range for the entire day, even though it’s way under the range for the time it was taken. There are sadly massive numbers of stories of this happening in the adrenal insufficiency groups

[peege in reply to JumpJiving]

Same here, brilliant practice & respiratory nurse in Wimbledon but rubbish one in Gloucestershire. Trying to sell up & move to Ely near family but not a good time for selling 😕. If I had the cash I'd see a private GP. It's g** awful that so many stagger through life with inadequate care.

[JumpJiving in reply to peege]

I was devastated to learn that the adrenal insufficiency that nearly killed me at the end of 2023 was caused by too high a dose of steroid inhaler, prescribed with no warnings, no steroid card, and no monitoring. I would have felt less bad about it had I had the auto-immune form rather than something doctor-induced. It’s why I mention it when I see people mentioning symptoms that sound all too familiar. Sometimes it cannot be avoided, but if one person (safely) avoids unnecessary adrenal insufficiency, that has to be a good thing

[peege in reply to JumpJiving]

Well, just bless you for keeping others informed 💐 💐

[Dixiegirlphyl]

Wow peeve, that does sound very extreme. Glad the switch has worked well for you. I’m going to give this a real go as the benefits sound great 🤞🏻

[Beth_19]

I have just been switched from Duoresp to Fostair because I struggle with the dry powder inhatation mechanism of Duoresp and I can Fostair with a spacer. I have found my symptoms are less controlled but I also know I am in a flare up which started back on the 8th June and has resulted in 2 hospital admissions and 2 lots of steroids, so for me currently I find its effectiveness not so great. I am supposed to be on the MART regime which has been mentioned so I can take 4 extra puffs a day but it is still not great so I ended up adding some salbutamol last night to further ease my symptoms.

I think its already been mentioned that it can take up to 8 weeks for true effectiveness, but if you are finding it really difficult it might be worth speaking to your team for advice.

[Dixiegirlphyl]

Thank you Beth_19. Sorry to hear you’ve been have a rough time since your inhaler was switched Ive heard the MART regime mentioned alongside Fostair in this, and other feed. I've now got an appointment with the asthma nurse next Monday so will enquire about this and see what her thought are about it potential suitability for me too .

[Birthday60]

I had a poor result from Fostair and am now on Symbicort and Seretide - my asthma is well controlled and allows me to have a very active life. Always worth perseverance with a drug change as it takes time to understand the impact especially with pollen so high right now if that affects you normally

[Dixiegirlphyl]

Thank you Birthday60. Unfortunately I am affected by the pollen…. Tbh couldn't have picked a worse time of year to change my inhaler !!

[Highlighter]

Seretide 250 X 4 times a day gave me a chronic cough for 6 years. Undiagnosed.

The cough disappeared as soon as I changed preventers.

I am not sure if Foster 100/6 is the equivalent and it may be worth checking.

I changed to Symbacort 100/3 and managed to reduce my dosage.

Severe leg cramps at night caused also disappeared immediately when I changed. I can only assume they were a side-effect of Seretide.

[JumpJiving in reply to Highlighter]

Highlighter Cramps can be a consequence of low cortisol. Seretide 250 users are supposed to be given a steroid card to carry at all times as that strength can result in suppression of the adrenal glands, resulting in low cortisol. I don't know about Symbacort, but in case your cramps were a result of low cortisol, I would suggest asking your GP to do 8-9am cortisol blood tests once or twice per year as part of monitoring your asthma meds going forward.

[Highlighter in reply to JumpJiving]

Gosh this is fascinating, JumpJiving. Thank you for that information.

It's lamentable that GPs or asthma nurses don't seem to know it - or at least none of the ones I came into contact with. I was on Seretide for 10 years.

The cough and cramps are all behind me now, with the change of medication, but perhaps that cortisol blood test would still be useful.

Thank you again. This site is invaluable for understanding asthma and taking some control over our own condition.

[Dixiegirlphyl]

Thank you Highlighter.. I’m unsure that Fostair 100/6 is equivalent either! I’m seeing the asthma nurse on Monday so will check and maybe even suggest Symbacort 100/3, very helpful.

[Patk1 in reply to Dixiegirlphyl]

Fostair is made up of much smaller particles than most inhalers,so more of it is absorbed.many of us are on mart regime with fostair.msybe worth asking about for when symptomatic.is salbutamol helping symptoms? I take fenofexadine in morn then loratidine in evening,along with montelukast,while pollens etc are high

[Catkin1960]

Sounds similar t the problem I had. Having stopped Fostair, following a visit to ENT at the hospital I feel so much better. However the asthma nurse at the Gps had just been trying to increase the Fostair. I was coughing every night and had no energy. I was on Fostair for about a year and realise now that it wasn't for me.

[Dixiegirlphyl]

Thank you Catkin1960. I think I need to investigate Fostair and its effects further. Bit of a minefield, if I’m honest!

[Dixiegirlphyl]

Well my asthma was really bad yesterday when I woke so got emergency drs appt.. different dr again. I asked about the disparity in strength bet Seretide 250/25 & Fostair 100/6… he’s up to 200/6. He also said I could use the MART regime plus ventalin when needed until back under control then to reduce. I also asked about using antihistamines am & pm which he confirmed. So thank you for all so much for all of your help … just need to get asthma and hayfever back under normal control 🤞🏻

[JumpJiving in reply to Dixiegirlphyl]

Dixiegirlphyl If you haven't got one already, make sure you get a steroid card that you carry at all times whilst on Fostair 200/6 (you should have had one one Seretide 250 as well).

See rightbreathe.com/medicines/...

[Dixiegirlphyl in reply to JumpJiving]

Thank you for this advice. Not been given or even offered a steroid card. On my list for next visit. The repercussions of inhaled steroids is not well explained by the drs, unfortunately ☹️

[JumpJiving]

If you’re not having adverse effects (such as vivid dreams etc) I’d stick with the Montelukast (I take it). Together with antihistamines (I am now on fexofenadine, having worked my way through the usual ones), anything that reduces the dose of steroids needed the better IMHO. Most of us cannot avoid steroid inhalers, as not severe enough to meet the criteria for biologics, but if we can reduce the dose safely, even slightly, it might save some from developing other problems

[Lysistrata Administrator Community Ambassador in reply to JumpJiving]

I understand what you're getting at JumpJiving, but I want to make it clear for anyone else wondering - generally people on biologics will still need a dose of steroid inhaler of some strength, though they may find they can reduce the dose of it and/or reduce other medications, if they respond very well. Reducing oral steroids is often the initial aim.

I just wanted to say this in case anyone gets the idea that qualifying for biologics means they will be able to stop all their other asthma medications (allowing for tapering as needed for anything steroid based to avoid problems with coming off too quickly).

It is typically not the case currently that biologics can replace inhaled steroids entirely, and for people with more severe asthma, biologics may help but not deal with everything. Particularly for those with more than one type of asthma - targeting eosinophils for example may leave allergic asthma still to be dealt with.

[JumpJiving in reply to Lysistrata]

Correct - I worded that badly. Thanks for clarification