I was taking one puff in the morning and one puff at night for a few years. Worked very well got me through a pregnancy etc with no asthma symptoms. Got a virus this year had a cough for a week or two felt my asthma flared slightly. Cleared up quickly. Asthma nurse said my dose of one puff in morning and one puff at night was a mistake all this time and I should actually have been on two in morning and two at night.
I have increase to two puffs at night and one puff in morning. This feels enough for me. It’s a strong inhaler and I don’t feel I need the two puffs in morning. Even adding the extra puff at night I had shakes, racing heart etc which I adjusted to the medication.
Is two puffs at night one in morning ok? I guess I feel like it’s working fine for me at this.
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Starlight1987
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You don’t say whether you’re on Fostair 100 or 200 but it doesn’t really matter. I have been on both and in each case, I have been told that one puff morning and one puff night is good because if you start to feel like you need a bit of extra help thro an infection, you can up the dosage to two puffs morning and two puffs nighttime. Then when I’m feeling like I’m over the infection, I just drop it back to the one puff am and pm again. Maybe you should just check with your asthma nurse, it could be a miscommunication.
It’s 100/6. The nurse said I permanently need to be on 2 in morning 2 at night. No negotiations basically. I am doing 1 in morning and 2 at night which I feel fine on. I know this is not the standard dosing but wondering if that matters.
I’m with Littleriahen on this one. According to the British National Formulary (bnf.nice.org.uk/drugs/beclo..., anything between 2-4 doses daily is recommended, and up to 8 doses if used as a reliever. In fact, I take 3 puffs per day of my Symbicort if I’m having problems; my consultant recommended 4 puffs, but didn’t argue about 3 as there is no “one size fits all” dose and it is not an exact science.
Unless your asthma nurse is basing her advice on a lung function test or spirometry which shows significant additional reversibility of your asthma at the higher dose and your asthma is otherwise stable, I would stick with what works best for you. You can always increase the dosage if your asthma deteriorates as the BNF suggests.
I'm on Fostair for over 2 years . I started on 2 puffs in morning and two at night as advised by Asthma nurse and have continued with this till now. Works for me, so I've never tried with just one puff. I'm male, age 70, never been been pregnant and I have COPD not asthma. Dunno if this helps, but it's just my experience with Fostair. If I experienced the side effects you got, I wouldn't be so happy with it. Did you tell the nurse re these side effects and what did the nurse say?
Yes I told her about the side effects. She didn’t say much or seem concerned. She said they would probably go away in a week or two as it’s a side effect of the medication. Took a few weeks but they subsided. This is why I am keen to stay on the 1 puff in morning and 2 puffs at night as not keen on getting another set of Side effects as my body gets used to another dose increase.
The dosage your nurse recommended seems to be the standard dosage. I've been on Fostair for several years like you, one in the morning one at night, with my asthma well controlled, though prescribed by a doctor abroad. My new UK doctor put me on the standard dosage but I'm not taking it. For a start, it's costing them twice as much to insist on that, but secondly why on earth should you take double the dosage when half works perfectly well?! We should be minimising the amount of steroid we're taking, to the minimum that will fully control our asthma.
If you're getting the shakes on that second dose at night, just don't take it. You know your body and everyone knows that's a sign you're taking too much bronchodilator. Additionally, most of these standard doses of medications are based on men's bodies. Women have many more side effects from medication because we are routinely told to take doses far too large for our bodies. That may be what's going on here.
If you've been fine on one dose morning and night for multiple years, that is good evidence this is the correct dose for you. Return to that and speak to your nurse to explain that you're getting the shakes on the dose she recommended and that it isn't appropriate for you.
Thanks I’m now feeling fine on the 1 puff in morning and 2 puffs at night. I feel like this is a compromise. The asthma nurse didn’t even want to enter into a discussion about it she just kept saying 2 in morning and 2 at night is the correct the dose and what I am taking now isn’t enough to give anyone control over a 24 hour period. It didn’t feel like a discussion I felt like I was being given a row by the headteacher. Not great.
I'm sorry you're dealing with this. Some medical professionals need to work on their patient manner! You were right to advocate for yourself and you know you've been fine on one dose twice a day for years so don't let her bully you into making yourself ill.
I was prescribed Fostair - 2 puffs morning and night. It made me feel sad, my legs had a crawling feeling and I had hand tremors. I told tge asthma nurse and she said she’d never heard of these side effects! I stopped taking it completely and she didn’t offer me anything else - she said I had asthma and she gives an inhaler for asthma. I was given tests by the hospital 6 months after tgat and they told me I didn’t have asthma! I’d trust yourself and your own dosage!
Hi, if you are using the Fostair 100/6 I think the usual starting dose is 2 morning and 2 evening, but if 1 morning and 1 evening is enough for you then there is no benefit in taking extra unless something upsets your lungs in which case you can go up to 8 a day. If you are using Fostair 200/6 the maximum is 4 doses a day. If you do start to need extra speak to your doctor if only so they can alter your repeat prescription. I've been taking both strengths over the years and just found I don't need as much as I did and the doctors are happy to have you on the lowest maintenance dose you can manage on.
My nurse seemed really angry when I suggested I either stay on 1 puff in morning and 1 at night or do 2 puffs at night and 1 in morning. She also wants to change my medication to save money to Luferbec. The whole discussion has left me feeling pretty low and anxious as I don’t like how she has been speaking to me. I don’t have a lot of other local gps near me so not sure who else I can speak to but would love to change.
The universal Stepwise Management system for asthma promotes reducing meds once a good period of asthma control is achieved. So it doesn't make clinical sense to increase an inhaler dosage if the patient is saying they aren't experiencing asthma symptoms and they're not using their short acting bronchodilator (Ventolin/Salbutamol) more than a couple of times a week or less. Even formulary standards recommend stepping down treatment when a period of asthma control is achieved. The aim is to treat the patient with the minimum amount of medication in order to achieve asthma control.
My asthma nurse is always keen to reduce my treatment when I'm doing well but always listens to my concerns and advises accordingly. I've managed to ditch the LAMA inhaler 3 years ago and hopefully my Fostair dosage will be reduced in due course, once I've had a good period of control. I haven't taken my Ventolin in weeks, so I know things are good right now. However, my asthma plan includes increasing treatment if my peak flow dips and my dependence on Ventolin increases.
I can understand your frustration with your asthma nurse experience.
Hello. Thank you so much for writing this "Fostair dosage question". I have been taking Fostair since 2017. I'm in my seventies. I have an asthma cough.
I am currently trying to personally reduce my official prescribed dose because of the side effects. As you say, shakes, racing heart and also I am sure it lowers my mood. There are also the cramps although one can walk up and down to reduce that. There's no way to make the body racing and low mood go, they just takes their course
When I first went on Fostair I was given different dosages to see how they worked. At one point 200/6 two in the morning two at night. That was way too much, I got increased side effects and no improvement on the asthma cough. They reduced my dose.
I have had a prescribed dose of 100/6 , two in the morning two at night now for some time. I think my body still finds this too much. The body races, heart bangs and mood is affected.
Also sometimes after puffs on the inhaler on the 100/6 two/two regime I suddenly feel 'worse' not better and have some unwelcome moments. I think my body is saying that's a dose too much.
I am currently trying one in the morning and one at night and the lower mood is much improved. I also think the body racing doesn't stay as long. I think I may need an occasional two at night. I am aiming for a settled dose to settle the side effects.
This is my personal experience. It may not suit others. It's important to consider checking with doctor and have regular asthma reviews.
Again thank you for posting this and everyone else for sharing those replies which have helped me.
1 In the morning and one in the evening would be considered a "low dose" however a moderate dose would be 2 am and pm .... but if a mid way works for you... I would ignore the asthma nurse (some of them are terrible)
The best asthma nurse I ever had was a "if it works for you, it's fine" person (obviously upto the safe maximums/prescribed dosage)
But I had a "you need to do this, I know best" ... we didn't get on she cancelled every follow up appointment with me for yeard after we had a rather large disagreement on who knew best about my health.. .. she left after a few years.
My now my asthma nurse is pretty good but self confesses she's out of her depth with me.
So if they say 4 and your comfortable and not struggling/suffering with 3... I would say that's OK.
thank you that is so reassuring 🙏 I feel like I am a fairly small petite person so a 4 puffs a day for someone who is say 6 foot is going to affect them less than me. So 3 puff a day feels enough especially as 2 puffs a day did me well for so long
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