Symbicort & Seretide/Advair

Hey,

After months on different inhalers, since starting Symbicort 200/6, (two puffs twice a day) my symptoms are finally getting under control and my peak flows have improved by 150l/min. This is waaay better, although I’m still getting symptoms when I exercise, coughing/mild wheeze 2-3 days a week but now only occasional 5am awakening.

My nurse’s response was sceptical: “But this is a long acting reliever! You shouldn’t need your blue puffer at all!” and is now giving me until February to step down a dose.

The thing is, I’m not a huge fan of Symbicort- and after a hurried introduction to the twist DPI mechanism I actually ended up giving myself no drugs for two weeks before I realised. Occasionally when taking it I cough, either when sucking in initially or when I try holding my breath so I don’t really get the meds I need.

My friends in the states recommend I ask about Advair (seretide)- Is it worth switching to see if the different drugs work any better?

I’m kinda nervous about flat-out asking for a different treatment, particularly as the surgery is so keen on ‘Symbicort Wonder Drug For All’, (even if you have reeeeally mild asthma like my mum!). Has anyone else switched and seen a benefit?

Thanks,

WheezySurf

[yaf_user681_26865]

Symbicort

Hi,

I recently changed to symbicort (beginning of last week - see my questions in medical worsening asthma) Like you, I have seen no benefit. It does not last the 12 hours, in fact after around 6 hours I need my reliever. Peak flow does not go above 400. I am also taking singulair. The reason I was put on symbicort was because I was initially changed to QVAR and my breathing went haywire. Going back to see my asthma nurse next week and will also be asking more questions in this forum.

Hope all goes well with you.

Woodies

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I tried symbicort but after using the training inhaler with asthma nurse it was decided that wasn't getting all medication needed as couldn't suck hard enough so I changed back to seritide with a top up of flixotide like had been on previous taking both through the spacer.

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I have changed to symbicort but find I need 3 puffs twice a day and somtimes I have to top up around 2-00pm with 2 more puffs. Maybe I should go and see my asthma nurse! I have tried ventolin in the afternoon but only get relife for about an hour.

Sheila

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Hi WheezySurf,

I'm glad to hear you've found a treatment that has given you so much improvement, although sorry that you're not completely happy with it.

Symbicort and Seretide are based on a similar principle, as you probably know - they both contain a steroid and a long-acting beta-2 agonist reliever. There's no good evidence that one is any better than the other overall, although sometimes different people respond to them in different ways and do have more success with one than the other. As you know, Symbicort only comes in the Turbohaler, which it sounds like you don't get along with. Seretide is available as an Accuhaler (a dry powder inhaler, but with small particles, so many people who used to struggle with dry powder inhalers can manage it) and as an Evohaler (a 'puffer' style inhaler). If you feel that one of these might suit you better, that might be enough reason to ask to try a switch.

Your nurse's response worries me a little - a long acting reliever is a useful addition to most people's asthma treatment, but it is not the be-all and end-all of asthma treatment. The treatment you are on is Step 3 out of the 5 steps of the BTS guidelines. To say that you shouldn't need your blue puffer at all (ie, to imply that you should be completely controlled) because you are on a long-acting reliever will be incorrect for a lot of people. Many people need an addition of a fourth agent to achieve control. I'm surprised that she is talking about stepping down treatment if you still feel that your control is not good, and you are using your blue reliever a lot, sometimes waking at night, and so on.

Do persist and go back to see your asthma nurse or GP if you are not happy. There is no reason why you shouldn't get better control than you have, as you are on by no means maximal treatment.

Hope this helps

Em H

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Thanks for your replies guys, you've made me feel much calmer!

I'm off to see my doctor in the next couple of weeks to talk over a few things, so I’ll explain the device problem to him and hopefully we can work out an alternative!

Asthma nurse is going to check again in Jan/Feb to see if the symbicort has reduced the lung irritation/swelling but I have been urged to make an appointment before then if things don't improve.

Thanks again,

WheezySurf