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Doubling of inhaled steroids


Sorry, I have another question.

Each time I have an exacerbation I get told in double the inhaled steroids. I know this advice is very old and thought that this advice had gone out of favour recently.

The other problem I have is that since I am on Seretide, when I double, I'm also getting double Salmeterol which combined with the Salbutamol makes me feel horrid.

What do other people do when they get exacerbations?

6 Replies

Good question.

Not sure I can answer but have been in the same situation. I was on Seretide 250 accuhaler 6 months ago and also told to double it, was told ok as licensed for COPD?. I didn't realise at the time but think that gave me cramps esp in hands and feet. Really only noticed the difference a month after asking to switch to Seretide 500. Worth asking if you stay on that dose?

I'm not sure what alternatives there are, I would think either split the inhalers so just the steroid can be increased or add in other medications. Have been told theophylline which is the only one I haven't tried is only prescribed in hospitals here.

Also, I had Atrovent inhaler added (which may old fashioned too I think) which has probably had the most benefit for me. The label unhelpfully said 'use as directed' but have found adjusting the dose can help and I have not been on prednisolone (5 short courses this year before it) since starting it?

Think I'll go and read the BTS (British Thoracic Society) guidelines again, available here if you want to see them. Will be interested to see other answers.


Doubling of the steroids is still the recomended course of action, however the combination inhalers like Serevent not only double the steroid but also the LABA component and in an ideal world that's not desirable. until few years ago and many still don't acknowledge it, but their is an increased risk of that causing GERD (reflux) and so make your asthma worse by night. Two options open to you, one is ask for an additional flixotide inhaler to use as the extra steroid when needed, or option two and one I do is just forget the combination inhaler and go old school and use serevent and flixotide as seperate inhalers and this gives you greater flexibility.


I found this and spoke to my consultant in Ireland about it. I'm now on both seretide and flixotide, so when I'm unwell I can just increase the flixotide and keep the seretide as is. It is definitely worth speaking to your dr about either splitting or adding.


Woody-som, didn't know that about reflux etc but did realise it can be more common with asthma or even cause a chronic cough.


There is info available here on the rationale and evidence on increasing steroid inhalers ""Step up usual preventative treatment - traditionally advice has been to double inhaled steroids in an acute exacerbation although the efficacy of this has been questioned by some. This approach is less effective in those already on high-dose maintenance inhaled steroids (e.g. >400 micrograms/day) who should should move directly to oral steroids. With those on low-dose inhaled steroids (e.g. 200 micrograms/day), advise to increase substantially (e.g. to 1,200 micrograms/day)


Many moons ago when I was on 2 puffs of Seretide 250 twice a day I was told by consultant I could double this up to four puffs twice a day.

However since then things have changed and now more or less permantly on this dose, do have occasional trial of trying to step down, but normally results in going back up again... On the four puffs twice a day there is little room for movement and normally results in the addition of another asthma medicine.


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