Alvesco and Fostari Together?

[Desoo]

Hello all,

I have been diagnosed with exercise induced asthma that's mostly triggered by allergies and most recently weather changes.

After bad experience with montelukast, having to stop all meds multiple times before finding what is going on (montelukast was making my asthma worse, even causing my corticosteroid inhaler to have opposite effect).

Anyway, my Fostair started working for the first time and it was AMAZING. I noticed i don't get numb feet during exercise. I'm having more energy while running and not that sensitive to allergens. And all with just 2 puffs of Fostair - 1 night, 1 in the morning every day.

But that lasted for a week. My GP wanted me off Fostair because apparently ICS/Laba everyday is not good idea because athletes build tolerance to LABA fast. GINA even advises against using LABA for athletes.

So ok, moved me to Alvesco 160 - 1 puff in the morning. I have been on that regime for a week and seeing no result at all. In fact, i'm returning back to square one. My numb feet are back, tiredness not that much since i'm using Salbutamol prior exercise, but i don't feel it's enough. The effect of Salbutamol before exercise is not the same as Fostair's.

So my question is,

Can i continue using Alvesco 160 - 1 puff/day and use 1 Puff of Fostair prior exercise instead of Salbutamol at least until Alvesco picks up and start working? I'm exercising 3 days a week.

Also, to those who take Alvesco too - how long it took for you to start working? I've been on week 1 and doesn't seems to notice any difference.

Thanks all!

[Homely2 Administrator]

My asthma has knocked out any pretence I ever had to be an athlete.

However if I do ever try anything, I find my salamol very useful beforehand. I have never tried taking my fostair 100 pre exercise, as I was always told to take my salamol then. If I am using my fostair 100 correctly and my asthma is under control, then my normal use of salamol is minimal, so using it pre exercise is highly effective. When my asthma control slips, then the salamol is less effective pre exercise.

I have never been told that the Ics Laba combination is an issue for athletes, so would love to know where this idea is coming for. Does your GP have a source for this assertion.? The combination of ics and laba is very different from taking laba by itself, which I have been told can be an issue for athletes.

So personally my first step would to look for evidence re your gp's assertion the the ics laba combination does not work for athletes. If you cannot find anything I would go back and ask your GP, for the source for their assertion.

This will then sort out whether you can stay on fostair 100, which I like a lot, so it is worth researching and discussing further with your GP before moving to an Ics only.

[Desoo in reply to Homely2]

Thank you for your reply, Homely2

My GP didn't say LABA does not work for athletes. What he said is that using it everyday leads to tolerance and better use separated ICS + SABA.

I checked his recommendation and it's based on two sources:

GINA (Global Initiative for Asthma): ginasthma.org/wp-content/up...

Section "Athletes" - it's advised against daily use of beta 2 agonists as it leads to tolerance.

There is two forms of advised therapies - ICS + Formoterol as needed and before exercise OR ICS daily + SABA before exercise.

I'm currently on the second option as the first one (ICS + Formoterol as needed and before exercise) is not suitable for me as i need to use it every day otherwise i have symptoms.

As per: "An Official American Thoracic Society Clinical Practice Guideline: Exercise-induced Bronchoconstriction" atsjournals.org/doi/10.1164...

It's advised against the use of Formoterol everyday as it leads to tolerance and loss of effect.

That's the reason i was pulled out of Fostair. Because only using it before exercise is not enough, but using it everyday may leads to loss in effect of LABA.

Instead I'm currently on Alvesco (ICS only) + Ventolin (SABA) before exercise.

But the SABA is not working good enough. It's maybe due to the fact i'm only 7-8 days on Alvesco and it needs to build up or maybe will never be enough - I don't know.

What i know is that the formoterol is working great taken before exercise, but i cannot buy it without the beclomethasone combination, so if i want to use it, i will need to take the Fostair.

As per the source i cited above, using Formoterol 3 times a weeks is fine and does not lead to tolerance.

That is why i was asking if it's ok to take Fostair before exercise and daily Alvesco 1 puff.

Thanks

[Patk1 in reply to Desoo]

I'd speak to Yr dr again

[My_fairy]

Hi

When my daughter first started using symbicort it took three weeks to work. It can vary but I think trying for 4 weeks is recommended to see if it will work.

Also, it’s a good idea to use salamol to open up airways before exercise but be wary of how much you can do as exercise causes symptoms afterwards aswell. I am not sure about the terms but for my daughter Relvar Ellipta was making no difference as Dre’s become resistant and symbicort was first introduced as her deliver but it’s her preventer aswell as reliever wifg combination of other inhalers for her persistent symptoms. I think it would be good idea to keep using both until the other works.

Can I just ask how did you get exercise induce asthma diagnosed? Was it through exercise test or generally through a GP as my daughters heartbeat goes fast and also breathlessness can be quite severe at times with little bit of activity although she enjoys being active.

[Desoo in reply to My_fairy]

Thank you for your reply. I got diagnosed by allergologist, but maintenance of my EIA is handled by my GP as i trust him and i don't have severe symptoms outside exercise.

With me, i never had shortness of breath. My symptoms were chest tightness that sometimes became so severe i was unable to exercise at all.

[My_fairy in reply to Desoo]

thanks for the reply yes she gets tight chest too also wheeze … her symptoms vary depending on inflammation … good to know though yours is somewhat controlled … yeah your GP seems to be good and knows what he’s doing …. Best wishes

[Emaych61]

I switched to Alvesco 160 from Flixotide 250 back in 2021. I know I was nervous about the once a day regime having had been used to a twice daily regime for inhalers for around fifty five years, but actually it wasn’t too bad for me. I was fine after a couple of weeks, but didn’t have much in the way of issues before that. It was explained to me that I could increase the dose to twice daily if I really needed to (but I was only on Alvesco) and it’s almost certain that I would have consulted with my GP or cons before doing so, but I never needed to do it - or not at the time. As would have been normal for me even when on the Flixotide I do have to increase the dose in winter months or if I go down with a viral infection but most of the time I use Alvesco 80 as a top in the evenings for that (though not always; earlier this year I had to increase to 160 twice daily but I got word through to my consultant that I’d had to do that: not long after I was offered an appointment from a cancellation so we could try to work out what was going on and how to proceed).

Depending on the form of exercise (I assume we’re talking aerobic exercise here) I would proceed carefully if you’ve switched inhalers. If something is making me more sensitive than usual doing three bouts of aerobic exercise in a week can cause problems for me - it did so back in June/July of this year and the same happened last year and I was well used to Alvesco by then, but something was making my lungs react to exercise more than usual. I’ve cut back since. I now do one lot of aerobic exercise a week (local ParkRun - though I fast walk it), one hour long stint of anaerobic exercise a week (a ballet class) and daily strengthener exercises most mornings (for about 15-20 minutes). That seems to be fine at the moment.

Hope things settle down for you soon, but I think you might want to adjust the amount of exercise you do whilst your system gets used to the new medication routine.