Hiya, I had my annual asthma review yesterday. The nurse told me that I need to have a MART care plan, which I am happy about as I rarely use my blue inhaler and if I do I always experience tachycardia and not much relief from the chest tightness.I am usually on Fostair 200/6 2 puffs twice a day and my asthma is well controlled. In fact apart from if a get a respiratory inection i frget i am an asthmatic.
This inhaler is outside of the formulary so she said I could try Fostair 100/6 powder inhaler which I declined as powders make me cough.
So she has prescribed Fostair 100/6 and said to take 1 puff twice a day and up to 6 extra puffs if needed.
I have been thinking about this and I will be going from 800mg of steroid daily to only 200mg which is a huge decrease.
I am hoping I will remain stable on this and not require the extra puffs unless I have a viral infection.
I understand the principle of using steroid and bronchodilator at the same time as needed, therefore hopefully reducing the need for oral steroids, but it just feels strange to be reducing my regular twice a day meds so drastically when they have kept me symptom free and controlled.
I like my twice a day routine and don't want to end up using my inhaler throughout the day.
Has anyone else experienced this?
Written by
Maya_227
To view profiles and participate in discussions please or .
Welcome . I understand your concerns. Why don’t you go back to your nurse and query the instructions. It would make more sense to me to take 4 puffs per day on the newer dose…….. however I don’t understand why you can’t stay on original dose and just use a bit more if required as part of MART regime? Last year my nurse wanted to reduce my dose which I declined to do. My breathing has been significantly better for a few years now and I was off the opinion let’s not mess with something that is working!!
Also give the helpline team a ring on Monday. They are very good and give good advice.
Thank you for replyin. The nurse said you can't do MART with the 200/6. I had 2 courses of oral steroids in January due to pretty mild viruses that just exacerbated my asthma. It does seem a good idea to use the inhaler more during those times.
You are right; you cannot do mart on the 200... there isn't enough wiggle room, with the maximum well tolerated dosage of beclomethasone being 800mcg ...however if it ain't broke, don't fix it
Now with you saying that apart from a chest infection, you forget that you are asthmatic... the asthma nurse maybe following the NICE guidelines which say after a period (I forget how long) of good control it's "sensible" to step down the therapy to the lowest dosage, while maintaining the "maximum" symptom control.... it just would be nice if they shared this information with you as they are supposed to "empower the patient to manage their condition alongside them" (and not telling you that if that's what they are doing is not really working together)
I think your nurse is quite wrong. As you say, if you’re stable on 800mg it makes no sense to reduce to one-quarter of that ie 200mg. The reason you hardly use your blue inhaler now is because you’re well controlled on Fostair 200/6. Why mess with what works? You don’t “need” to be on a MART-compatible plan. It seems to be the latest obsession of some asthma nurses
I was in a similar position to you, on Fostair 200/6 2 puffs twice a day. and asthma not controlled (having to top up with additional steroid inhaler). When it was suggested that I move to 100/6 on MART I was really concerned because of the reduction in steroid dose. I made the change at a time when my asthma was as well controlled as it could be, with no respiratory infections. It has worked well for me, and being able to have extra puffs when needed has generally worked well when needed. But - I have never managed to get down to 1 puff morning and evening and use 2 puffs morning and evening as my maintenance dose. Consultant and GP asthma nurse are happy with that. It doesn't match the standard MART regime but has reduced my steroid intake hugely.
Also, for me Fostair does not act quickly enough as a reliever if I have full blown asthma attack, so I use ventolin then (luckily this is rare for me). If the asthma flares more gradually then increasing the Fostair usually works well.
I too find it odd that you should reduce from the 200 to only one puff of 100.MART = Maintenance And Reliever Therapy, I am on Fostair 100 but prescribed 2 puffs am & pm, I can add up to 4 more puffs daily or reduce to 1 on the good days - ie for me the summertime. Between seasons I'll have one puff am (unless I'm expecting to exert myself) and two puffs before bed (nights are my worst times). Only need ventolin during infection or exacerbation.
Hopefully with decent support you'll work out which is best for you - I'd have thought change from the 200 to two puffs of the 100 at first, use an extra puff or two if you need to whilst you get used to it then reduce more gradually - but of course I'm not a medic!
There's always the helpline for professional, experienced advice & guidance. 0300 222 5800 uk office hours. P
I was recently changed to the Fostair Nexthaler on MART, it was changed after 2 courses of antibiotics alongside steroids. It was explained to me that my asthma exacerbation was probably because my sirdupla inhaler was becoming less effective as I’d been on it for 12 years. I was sceptical about going on a powder inhaler, and particularly on MART, at a reduced strength, but my asthma nurse suggested to still take 2 puffs morning and night, so I ran with it.
For me the switch has been worth it. My asthma( touch wood) is well controlled to the point I almost forget I’m asthmatic. I’ve not had to reach for my inhaler outside of the two puffs morning and night, at all, even during a recent chest infection, when I would normally be using my salbutamol inhaler a lot!
Maybe a call to your asthma nurse expressing your reservations and maybe asking if it’s possible to start on 2 puffs twice daily would be acceptable for you? They can only say no, in which case you can try and open a dialogue into a way forward , one in which you have confidence.
Sorry you are having issues with MART and agreeing a helpful regime to help you with the asthma,
Others here wiser than I have offered you their advice and I would only add that you perhaps request a referral to your local respiratory service ( or respiratory champion if there is one ) for a review of your situation and a plan which you will feel will be helpful.
My asthma nurse wanted me to change inhaler and go onto MART using Fostaire. I asked for written info and said I would consider it. She was really giving me the hard sell. I was due to see my RESP consultant a few weeks later so discussed it with them.
He told me that it was unsuitable for me as it would be a decrease - a step down, he called it when I really required to go UP a step.
He changed my inhaler and wrote to the surgery saying that the Fostaire MART option was not for me. He then advised that if I was not doing ok with the new inhalers he had prescribed they should try me on ... (can't remember the name and don't have the letter handy).
There seems to be a lot of dabbling going on. As you say, why change something that's working perfectly well.
Hi Maya! I have nothing to suggest re the inhalers you mention and I think there have been several helpful comments. What I do suggest is - if you don’t already - that you take vitamin D3 to boost your immune system to hopefully reduce infections and occasionally, especially if you have an infection, a short course of a good tonic containing iron. I have found this to be very effective. I wish there was a move towards checking vitamin and mineral levels in the blood of asthmatics. If the levels fall below what is considered ‘normal’ then obviously the body gets stressed and we all know that stress often leads to an asthma flare up.
My nurse changed mine to the nart regime and put me on 100/6. I was previously on 200/6. Even with the extra doses this didn't work for me so changed back to the original 200/6. I am much better on that.
The Powers That Be (Nice) have deemed that we should all follow MART now if possible plus we should be using the powder inhalers as they save the planet. However, your wellbeing is paramount in their guidelines and your wishes take priority over their recommendations.
MART is not an option for me, neither are powder inhalers so I have made that very clear at every appointment. I'm now on Fostair 20/6 (2 puffs twice a day) plus Sprivia (2 puffs in the morning) which has finally got me back to where I was last year. I was diagnosed with eosinophillic asthma with possible COPS overlap after Type 2 respiratory failure so this has been a huge learning curve for me.
See how you go on this new regime but monitor both your peak flow and oxygen levels and if you're not happy then please go back to the nurse and if necessary, ask for a referral to a respiratory consulant.
I don’t understand why your dose has been reduced so much as that. I have been on the Fostair mart plan for around a year but at 2 puffs twice a day and can take extra puffs as needed. I often take 2 more puffs and occasionally more during the day and it has been working for me.
I also have a rescue inhaler for emergency use which I’ve rarely used since being on the mart plan.
I would suggest discussing this change with my respiratory Consultant before making any changes Maya 227,if you have no problem just now with your current medication,I would most definitely seek advice from my Consultant... Wishing you well Maya 227, with much love, 💘 & God bless you always..Primrose 123...( Maria)..x
I cannot comment on your precise question because I am currently on Fostair 100/6 but was moved across from a Seretide powder inhaler. I am on 2 puffs twice a day and can take up to a further 4 puffs if I feel the need. I never found benefit from the emergency inhaler but if I get short of breath it has not to date ever felt drastic anyway. I can generally control it by breathing and slowing activity. It does seem weird to drop you quite so drastically and I think it is worth querying. Maybe 1 puff twice a day is the starting dose for a first time prescription but if you are moving from another regime that works well I would have thought they would try to mirror that regime reasonably closely before reducing dose again.
I would also bear in mind that it is all very well for them to say you can take all these extra puffs but my surgery is very bad at prescribing sufficient inhalers that I actually have the wiggle room to take the puffs if necessary. My repeat prescription allows one inhaler per month which is fine for my 2 puffs twice a day but gives no leeway, and trying to get an interim emergency prescription is nigh on impossible. Because I have not needed an emergency puff and I can get a repeat a couple of days before the month is up I have built up a buffer zone over time. But you might want to have a think about that and make sure you have suitable supplies in case you need emergency puffs.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
ive been wheezing a breathless for couple of yrs went to docs befor xmas he gave me ventalin 2 puffs 4 times a day ,
Emphysema,new inhalers
MART Regime
New Toy!
Fostair doesn't last all day
