Being referred back to hospital - any ideas on drug treatment?


I'm new to the forum. Had asthma ""officially"" for 6 years after a respiratory arrest (turns out that darned permanent cough actually hadn't been....oops). I have been told I have brittle asthma due to the very rapid deteriorations I have whilst being pretty well in between.

Anyway, have been really quite unwell over the past few weeks and increasingly so this week. As per my asthma plan I have been doubling my seretide for the last 6 days and started my emergency steroids on Tuesday.

I went to see the nurse yesterday as I am having lots of breakthrough symptoms and had to have a neb on Tuesday (don't have one at home), the nurse was horrified that I've been doubling my seretide (I'm sure that's what they said to do at hosp) and apparently I have now exceeded the treatment my GP's surgery can give and have to be referred back to the hospital consultant for an urgent appointment.

I'm on Seretide 250/25 and ventolin, currently using the ventolin about 15-20 times in each 24 hour period and was seriously considering calling ambulance at 2am last night.

Essentially what I'm asking is does anyone know where I'm likely to head next with medication? I was on Uniphyllin (not sure on the spelling!) before but it didn't agree with me as it made me really dizzy and nauseous.

Anyway, hopefully some of you kind people can help me with your words of wisdom!


14 Replies

  • Very quickly uniphyllin often does make people feel a bit grotty at first if it carries on then they need to do a simple blood test to check the levels and see if you need a lower dose. Also some people don't get on with uniphyllin but get on with phyllocontin (same drug roughly) don't be suprised if the hospital suggest you try it again. And if the side effects are bad you can stop them and they are out of your system in 12-24 hours and they will have peaked at about 6 hours.

    Best of luck


  • Thanks for that, very interesting. When I was on Uniphyllin before I never had a blood test, when I complained of side effects they just stopped it!

    Hopefully the appointment will come through fairly quickly, I'm off sick from work at present and would rather not be.......and I really don't want to end up as an inpatient again.

    Take care all and thanks again,


  • Hi Fee, welcome,

    The doubling of seretide is a bit of a questionable one. I was told yes but also no because it meant doubling the salmeterol content, and the recommended thing was to contact my GP for a seperate steroid inhaler. Anyhow, since I was told this last year the information regarding salmeterol has changed, and is now licensed for higher dose, which is effectively double what you get from your standard dose from seretide.

    I've not had chance to talk this through with anyone, but based on the new license it should be in theory fine to double dose with seretide when ill, but the guidelines for seretide haven't been changed yet. I did double up myself a while back for a week, and was fine, so do so if you were told, but certainly not a long term recommendation.


  • Hi Chris - thanks for the welcome!

    Hmmm...I see what you mean. The asthma nurse did offer me a higher dose Seretide which is apparently usually used for COPD patients which I think she said is 500/50, surely that's just what I'm getting by doubling mine?! Anyway, as it's a dry powder inhaler I declined as I really don't seem to get on with those. They make me cough like mad and seem to irritate my symptoms rather than alleviate them.

    I am feeling a bit nervous about a medication change to be honest as my asthma has been stable for quite a while now and I am anxious not to return to the unstable state I was in where I had repeated emergency admissions, HDU and ICU and all the very unpleasant things that go along with well as the fear of course!

    Of could be said that I have already become unstable again..ho hum..hopefully things will start to settle.


    Thanks again


  • Hi Fee,

    Accepting the 50/500 seretide would be a good idea. You use the accuhaler ?

    Basically you have seretide 50/250/, and a normal dose would be 2 puffs so thats 500 fluticasone and 100 salmeterol.

    If you double your usual dose you are taking 4 puffs and that means you get 200micrograms of salmeterol, which is higher than the recommend level, and yes, you shouldn't be doubling up your present inhaler.

    If you had the seretide 50/500 then that would double your steroid dose, and still leave your salmeterol at the maximum dose.

    If you dislike the powder, why not try the evohaler and a spacer.


  • Just evohaler says 25 micrograms of salmeterol and 250 of fluticasone, I'm taking 4 puffs twice a day. The asthma nurse told me that the 50/500 only comes in a dry powder?

    I'm a bit biased towards evohalers as I really don't like the thought of inhaling powder, which I think is probably why they make me mind playing tricks on me.

    Sound advice though and very interesting about the asthma must be even more unstable at the mo than I had realised given that salmeterol is a long acting reliever.

    You are all very knowledgeable about the different that just through personal trail and error and experience?


  • Hi Fee,

    You use the Accuhaler? so that's currently 1 puff twice a day of 50/250

    If you double it, that means 100micrograms of salmeterol per dose, and that is since earlier this year, the new recommended max dose, and should in theory be fine. However as there is the option of having the 50/500, and you were offered it, then take it.

    I see that you don't really like the powder, so why not ask for seretide 25/125 evohaler and use a spacer, and you then take two puffs twice daily instead of your present 1. or if you are bad and need the boost 25/250.


  • Fee,

    Sorry, must have read the post wrong, evohalers do have a max of 25/250, and the guidelines do state 2 puffs twice daily, so if you require extra steroids, then you can always ask your GP for something like Flixotide, which will give you the extra you require.

    The 50/500 dry powder one you were offered isn't quite the same, you only take 1 puff twice daily.

    The license for salmeterol (serevent) was changed earlier this year, and now it's possible to take up to 100micrograms twice daily, but the change hasn't been applied to seretide yet, so yes short term double dosing should be fine.


  • Hi Chris,

    Thanks for this - I don't think it was you getting confused...I put the wrong dosage in my original post and didn't say how often I was taking it!

    It's good to know that I'm ok short term with what I'm taking - hopefully the appointment with my consultant won't be long in coming round, she's great and very approachable.

    Thanks for the help - this forum is great.


  • Hey Fee,

    Just a thought have you tried montelukast (Singulair) which is a leukotriene receptor antagonist?

    Also the consultant might change your inhaler possibly from seretide to symbicort, there are also quite a few other options but i suspect these would be the first steps. I hope everything goes well!

    ally x

  • Thanks Ally,

    No I haven't been tried on those. This is most useful, I'm getting the chance to look at these treatments and benefits/side effects before I go for my appointment. Makes me feel a little more in control (and yes...I am a control freak!).

    I like to be prepared for these things so that I can make informed decisions on possible treatments suggested.



  • Hey Fee, Don't worry I'm a controll freak aswell, I like to understand eerything that im being told by my consultant and the reason I'mn on each drug... i guess its trying to find some controll out of my uncontrolled asthma! It might be a thought to go and ask your GP to try you on Singular (i think it was my gp who first put me on it) as they can prescribe it and in somepeople it can have a significantly positive effect on their asthma controll, which will give you something to try while you wait if your consultants appointment is quite some time away.


  • Fee,

    Ally is right your GP can prescribe singulair, I went and asked mine for it, but it was to stop a persistent cough, he tried to talk me out of it, but after a while I convinced him that it was worth the trial or I'd sell the bike, throw the trainers in the bin and take up drinking and sit on the sofa all the time, as it was exercise that caused my cough. It works for some and not others. An alternative to Singulair in the same class of drug is Accolate.

    There are a lot of drugs to try, some work for one but not another.

    here to make life easy for you are a list of common ones, by the drug name, but in brackets more common names.

    Inhaled corticosteroids, Fluticasone (Flovent/Flixotide), Budesonide (Pulmicort) , Triamcinolone(Azmacort), Flunisolide (aerobid), Beclomethasone (Qvar/Clenil), Mometasone (Asmanex).

    Long acting beta agonist, Salmeterol, Formoterol,

    Leukotrine modifiers, Montelukast (Singulair) or Zafirlukast (Accolate) - This type of drug blocks the production of leukortienes-immune system chemicals that cause asthma symptoms, and can be used on there own or more commonly with corticosteroids.

    Then there are drugs that are used to treat more difficult cases, that GP's can't usually prescribe.


  • Wow!

    Thanks Ally and Chris - knew you guys would help me out (grins), you're all very knowledgeable about the drugs available - off to do some looking up now in mims and the bnf!


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