Is anyone else getting pressure to lower their dose

[Lemonade91]

I wrote here previously about my issues with the asthma nurse at my surgery. After a big drama I was changed to lufrobec. It gives me a bit of a cough but nothing like the side effects I experienced on fobumix.

I have been taking it around a month, two weeks ago I had a call from the pharmacist at my pharmacy, we chatted through my previous medication (clenil 200mg x2 puffs morning and evening, Serevent 25mg x2 puffs morning and evening and whatever brand of blue inhaler the NHS favoured at the time as a reliever). She checked the doses and said that the 100/6 lufrobec is the equivalent of what I used to take but I need to take two puffs morning and night rather than one.

Had the four week checkup with a nurse at the GP practice yesterday, and I told her about the upped dose, she said that I can take upto 8 puffs of the lufrobec each day so if I’m take four I need to be careful as that only leaves me with four. I was like okayyyy well I can count and I don’t need to use the reliever for day to day activities when my asthma is well controlled. We talked about the fact that I DO use it when I exercise and I have trouble getting through exercise without needing it which has been a continual problem. I have not needed more than two puffs and one is usually enough.

She told me to keep going with two puffs morning and evening and hopefully in a few weeks it’ll be fully in my system and then we can look to dropping it back down to one puff for the maintance

am I just not understanding how the MART process is supposed to work? Why do the nurses keep talking about wanting to drop the dose? I don’t think it’ll work I think I’ll be in the same situation where in the middle of the day and night I need to take an additional puff when just doing regular daily activities. I’ve been hospitalised before with severe asthma attacks and when I spoke to asthma and lung uk around that time the nurse I spoke to (who was fabulous) said that sometimes it can happen for mild asthmatics but as I’ve been so poorly in the past it’s unlikely to happen for me.

I just wondered if anyone else had experienced this

[Ergendl]

Sorry I can't help you with your precise query, but I do know there are good resp nurses and not so good resp nurses. The one at my surgery is the sort: if it's working, don't meddle. Sorry if yours isn't.

Unfortunately, surgeries have been instructed to cut the amount they contribute to what the NHS spends on prescriptions. So I've had a surgery pharmacist try to force me to take a capsule form of a med instead of a tablet, even though that causes me serious side effects - a battle I have to fight every two to three years.

[Patk1 in reply to Ergendl]

That's awful Ergendl.u shouldn't have to keep going through it

[Lee_Scoresby in reply to Ergendl]

Capsules cost more than tablets. Isn’t that what you find if ever you have to buy them for yourself? Your pharmacist might have other, more benevolent reasons for suggesting you change.

[Ergendl in reply to Lee_Scoresby]

Sadly no,  Lee_Scoresby . Their email telling me they had changed the prescription specifically said it was to cut costs. The NHS negotiates prices with the pharmaceutical companies for the meds it supplies, so NHS costings do not always reflect over-the-counter costs.

[Alberta56]

An experience like yours gives the impression that the NHS does not regard lung disease as worthy of the care some other illnesses get. (I hope there is not a lingering belief that asthmatics bring it on themselves and could control it if they really wanted to.) Hope you'll be able to withstand the pressure and keep the medication regime which suits you. Best wishes.

[knitter in reply to Alberta56]

Plus the constant linking of COPD and smoking ….i just wait every time for the question .

My neighbour never smoked but has COPD and asthma .

[PaulineHM]

Hello

I know changes suggested are sometimes tricky to see the point of aren’t they.

There has been a recent review of managing Asthma by NICE, so that is maybe why the pharmacist is making the changes they have suggested ?

Have you asked why ?

Go well

Pauline

[anng1814]

I had a phone call from a local pharmacist, as I had started new medication. She wants to lower the dose of Clenil 200 in 3 months and wants to wean me of ventolin. I'll see if the same pharmacist is about in 3 months time, as they keep changing!

[MoyB]

At my asthma review with the nurse at the surgery I was encouraged to change to the MART system using a different inhaler. I asked for some written info and said I would consider making the change.I was due my general resp review with my consultant a couple of weeks later so took the info and asked his opinion. He said it was 'a step down' and 'not appropriate '. He changed me to higher dose inhalers and wrote to the surgery with his opinion and told them that if I needed a change of inhaler, the next one should be XXXX ( can't remember the name but have it on file).

Just saying!

Xx Moy

[jackwok]

I was put on to Lufrobec to replace my Fostair. After two weeks I thought it was no improvement so spoke to one of the senior doctors at our surgery. She immediately put me back on Fostair. Six months down the road I was hospitalised and put on Trimbow as that was the only one they stocked. This was September and it worked well and I am still happy.