ACOS and mart regime

[Gazza01]

Hi all. I have asthma and copd. For a while now I have been on Fostair 100/6. It's ok but doesn't seem to last the full 12 hours and sometimes I notice a definite dip in my breathing just after taking it. I asked if I could just take ventolin in between doses which I could fit in with my exercises as I do get good relief from it, rather than take more steroid, which I don't feel I need as I don't have asthma attacks or lots of mucus and have no cough or issues at night I don't get short of breath only puff and pant a bit up steep hills or when exercising, And as an ex 30 a day man for 35 years I reckoned that's about right. But I never gasp for air or get air hungry, not yet anyway.

But no, I've been told by the asthma nurse and GP that I should use the fostair as maintenance and reliever therapy. Which I felt was not really good for the COPD side of my issues. I will be going back after my holiday to ask for a change over to seritide to see if that's any better. Has anyone else on here with asthma and COPD been told to use a combination inhaler as maintenance and reliever?

[Hidden]

I use fostair pump with a spacer and it is 100/6. I still have to use my blue inhaler on an occasion but my fostair does what it is meant to. I have been on fostair for 4 year's about. And now montelukast just to help as my hayfever was annoying my asthma

[Hidden]

I am on forstair 100 for my asthma and seebri for my copd. Like you my forstair doesn't always last the full 12 hours my respiritory nurse said I it was ok to use my ventolin which I do on occasion as it does help with my breathing. I know it can be used as preventer and reliever, but I have only ever used it as maintenance

[Gazza01 in reply to Hidden]

Mmm.. I spoke to a asthma uk nurse and she said if you have COPD you can use ventolin up to 4 times a day when required. Which I told the GP but still she pushes for more steroid. Another asthma uk nurse told me I was obviously getting enough steroid as I don't have a wheeze or cough or mucus etc. They seem to be treating me as an asthmatic only. The GP keeps saying if you need ventolin then your asthma is not controlled.

I'm going to give it a go with the fostair probably 6 puffs a day for a couple of weeks and see if she's right. I just didn't think they should go down that road if you have COPD. I think it's all the same to them sometimes. I really do.

PS when I told the asthma uk nurse that the Fostair wasn't lasting long she said ' we hear that all the time'.

[Hidden in reply to Gazza01]

One of the respiratory nurses said if I was very breathless 4 puffs four times a day and I have done just that with the ventolin ...when I have needed to. Let me know how you get on with increasing forstair

[Hidden in reply to Gazza01]

What other meds are you on

[Gazza01 in reply to Hidden]

I tried spiriva as an add on but after a few days I didn't feel it was making any real difference. Then I started to get palpitations. I read up on spiriva and found it was banned from the states because of a link to deaths in people with heart issues. Which I also have so I packed it in. That was a few weeks ago now and not really any different to when I was on it. Honestly if I could take ventolin 4 times a day my breathing would be great as it's always really worked well for me. That with a separate steroid would be ideal. But I think with all the asthma deaths they are desperately trying to only use combi or triple inhalers now. I was offered the new trimbow inhaler but had read some people were trying to get back to thier previous mess as it wasn't doing it for them. My wife said just take the ventolin when you need it. What do they know. Tempting.

[Hidden in reply to Gazza01]

Like I said the forstair 100 doesn't always help as for the seebri not brilliant..spiriva gave me hives but stopped working had other side effects....I didn't actually know there was such a big issue with using ventolin..I use it if I am struggling and I don't gasp for air yet...only when it was hot ..

So what have you been told about over using ventalin

[Gazza01 in reply to Hidden]

It's not so much about over use. The problem they have is that many people were using the ventolin and not bothering with the steroid. Then they would have an asthma attack and die. So now ventolin is suddenly looked on as a no no. Hence all the combination inhalers being pushed. And it's about to get worse as the last years results only came in a few days ago and asthma deaths up yet again. It wasn't all down to people doing this but some were.

[Hidden in reply to Gazza01]

Oh ok got it I still use my forstair but will use my ventolin

[Hidden in reply to Gazza01]

Is your copd emphysema..what stage are you

[Gazza01 in reply to Hidden]

I do have emphysema but also COPD from the Spirometry. The GP said mild as did the read out from the machine. This was post bronchodilator which showed I had a fair bit of asthma. In reality I only have what feels like a restriction in breathing which seems to be at my throat rather than chest. I've told them this but it doesn't seem to make any difference. I have no wheeze no cough. No SOB to speak of no issues waking up at night. Never had a chest infection. I do get very tiny flecks of mucus but not every day. I exercise on a treadmill 7 days a week and yoga too.

The emphysema was found by chance on a CT scan when I went for my heart op. They didn't even mention it to my GP it was just hidden in the notes as ' there is emphysema but no mass lesions'

I found it a year after the op when going through my medical record. When I told the GP he just said ' oh well at least you're already taking the right medication, you'll be fine. Trouble is in about 8 years I will need another heart valve op and I'm hoping my lungs are still OK by then or I might be screwed as I don't know if they'll do the surgery. I'm only 55. Hence all the exercise, I'm already getting myself ready for the battle ahead. We'll see.

[Hidden in reply to Gazza01]

Right so isn't your copd emphysema confused..I never had ct scan and was told suggestive of mild emphysima via single breath defusion. As I have asthma I an confused if my 79% fev1 is asthma or the emphysima component..and consultant won't give me a scan..

I am sure if you are doing everything you need to do your lungs will be fine

A member on here said he was moderate since 2005 and is still moderate...

[Gazza01 in reply to Hidden]

You can have a small amount emphysema only without it showing up on spirometry. Then it's just emphysema Once you have a fixed airway showing on spirometry they call it copd. As far as I can tell it is a bit confusing. I take it you did a spirometry with a reversibility test. Lots of blowing out. Then usually four puffs of ventolin then 30 min wait and then do spirometry again to see if it's different after the ventolin. I can't see how they can diagnose asthma otherwise. I had a fixed airway to obstructive before the ventolin. Then did it all again and it went to mild obstruction. So it reversed with ventolin from obstructed to mild obstruction with reversibility being 18% of my breathing and an extra 320 ml blown out after the ventolin. You have had spirometry haven't you?

[Hidden in reply to Gazza01]

In Jan just had spirometry before inhaler 62% after inhaler 77%

In may had spirometry no inhaler 79% they did another 2 test 2nd showed minimal residue 3rd single breath diffusion which checks for emphysima he said he concluded mild dont know how he came to thst conclusions the more I think about it

[Hidden in reply to Hidden]

He said my reversibility was 22% in January think coz I didn't have ct scan and am breathless puffy

[Gazza01 in reply to Hidden]

22% is full on asthma. If you have 400ml reversibility I think.

[Hidden in reply to Gazza01]

That's what he assumed did further test..this single breath diffusion which checks for emphysima test that gave me my emphysima he said mild but feel I should have a ct scan to establish if I am in fact mikd

[Gazza01 in reply to Hidden]

I was told by a GP and an asthma nurse that anyone who has smoked for a long time will have some emphysema. They may not get any issues from it. But once it's found people would be crazy to keep smoking if they still do.

When mine was found they didn't tell me or my GP. It was tucked away in the medical notes. I found it a year later.

[Hidden in reply to Gazza01]

Really..I am realising now I don't know if it's my asthma or my emphysima or stress that is causing my breathing to be up and down..

[Gazza01 in reply to Hidden]

Exactly the same as me then. I know if am am very chilled my breathing seems better and certainly instantly tightens up if I get bad news or am very worried about something( which is most of the time as I am a big worrier) I didn't think I had any asthma triggers. But I have been thinking recently that stress is certainly one. And it is on the official lists of asthma triggers. My GP says most of my breathing worries are because I'm focused on it. Which is true. But if I didn't have it I wouldn't worry about it. It's a vicious circle. Strangely I had a bout of quite bad palpitations recently, probably stress related, but as I had open heart surgery just a couple of years ago, palpitations are a lot more scary than they used to be. Funny though, while I was having them and my focus was on my ticker, my breathing was actually fine. As soon as the palpitations started to go away after 4 days suddenly I felt that horrible laboured breathing come back. Just shows i am certainly focused too much. Bloody shame you can't switch it off. Because nothing I've tried works.

[Hidden in reply to Gazza01]

I think it is easy to say you focus on your breathing too much...I do not think that can be helped I have disfunctional breathing as an add in to my diagnosis..I don't breath properly my consultant says well gosh really thought I ..tell me something I don't know