Hey I'm sorry I know this is all probablly common knowledge but am just looking to pick brains for a bit of information before I see asthma nurse on Tuesday.
I was at asthma nurse on Thursday due to peak flow being at 60% of my usual peak flow, I know it's not really low but I had been taking salbutamol once an hour to keep it there and due to being pregnant I was a bit worried about it and not wanting my peak flow to drop much more due to oxygen levels for baby. My asthma nurse suggested taking 3 puffs of seretide morning and evening instead of my usual two and taking 10 puffs of salbutamol 4 hourly...so I guess my questions are...
1) I though I had read that the maximum dose of serevent you should take in 24 hours should be 100 micrograms am I wrong about that then? If I'm not wrong then would upping my dose to three puffs of seretide twice a day not put me over that amount? (I could quite easily have imagined reading that though, pregnancy brain!!)
2) The fact that I am taking so much salbutamol (when my body isn't used to it) and it is increasing my heartrate to about 150 beats per minute will this affect the baby?
Thanks for any help, sorry for asking I am just paranoid as during last pregnancy asthma was fantastic and had no problems whereas this time it seems very unpredictable and don't want anything I am doing to harm my baby.
1) Not sure that's true. Seretide can go up to 500mcg, and that can be twice a day. So 100mcg is nothing really compared to that.
2)Not too sure, but I'm sure one of the med bods will be around soon to help!
Hope pregnancy is going well!
Vicky xx
I can't answer question 2, but have the info that the docs use, and the dosage for serevent is 2x25mcg twice a day, but in more severe airway obstructions upto 4 inhilations of 25mcg twice a day may be of benefit, so you should be fine. I was advised by my GP though when I asked about seretide, do I double it up during bad periods, and was told thats not what you do with seretide. I have some clenil modulite to add to the steroid already in the seretide, and this seems to be the better way to go, as the recommended method is to double up the inhaled steroid.
With Seretide, as it is a combination inhaler of Serevent, A long acting bronchodliator and Flixotide which is the steroid component.
Seretide comed in diiferent strengths but where as the steroid component varies, the serevent component is always the same regardless of how much steroid ( Flixotide) there is in it.
I take two puffs of Seretide 250 twice a day but then top up the flixotide bit with flixotide to increase the steroid component only.
Serevent component will have similar side effects in higher doses as ventolin does.
That on top of all the ventolin will make your heart race.
I am not up on asthma and pregnancy but I would advise that you get an urgent appointment to see your GP or even ask your midwife. 150 is very fast.
If your at all concerned please call nhs direct or even go to your a&e dept & don't be worried about making a fuss as there are two of you to be looked after at the mo.
Take care
Kate
XXX
re:serevent and pregnancy (copied from information provided to the doctors.)
This is the only info I know off, make up your own mind.
4.6 Pregnancy and lactation
There are insufficient data on the use of salmeterol or this medicinal product during pregnancy and lactation in women to assess the possible harmful effects. In animal studies fetal abnormalities occur after administration of beta-2-adrenoreceptor agonists (see Section 5.3).
Use of Serevent Evohaler during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the fetus.
It is unknown whether salmeterol is excreted in human breast milk. Animal studies in rats have shown excretion of salmeterol in breast milk. A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy with Serevent Evohaler should be made taking into account the benefit of breast-feeding to the child and the benefit of Serevent Evohaler therapy to the woman.
Studies of HFA-134a revealed no effects on the reproductive performance and lactation of adult or two successive generations of rats or on the fetal development of rats or rabbits.
5.3 Preclinical safety data
The only findings in animal studies with relevance for clinical use were the effects associated with exaggerated pharmacological activity.
In reproduction and development toxicity studies with salmeterol xinafoate there were no effects in rats. In rabbits, typical beta-2 agonist embryo fetal toxicity (cleft palate, premature opening of the eye lids, sternebral fusion and reduced ossification rate of the frontal cranial bones) occurred at high exposure levels (approximately 20 times the maximum recommended human daily dose based on the comparison of AUCs).
Salmeterol xinafoate was negative in a range of standard genotoxicity studies.
The non-CFC propellant, norflurane, has been shown to have no toxic effect at very high vapour concentrations, far in excess of those likely to be experienced by patients, in a wide range of animal species exposed daily for periods of up to two years including no effects on the reproductive performance or embryofetal development.
VENTOLIN AND PREGNANCY
4.6 Pregnancy and lactation
Studies in animals have shown reproductive toxicity (see section 5.3). Safety in pregnant women has not been established. No controlled clinical trials with salbutamol have been conducted in pregnant women. Rare reports of various congenital anomalies following intrauterine exposure to salbutamol (including cleft palate, limb defects and cardiac disorders) have been received. Some of the mothers were taking multiple medications during their pregnancies. Ventolin Evohaler should not be used during pregnancy unless clearly necessary.
As salbutamol is probably secreted in breast milk, its use in nursing mothers requires careful consideration. It is not known whether salbutamol has a harmful effect on the neonate, and so its use should be restricted to situations where it is felt that the expected benefit to the mother is likely to outweigh any potential risk to the neonate.
5.3 Preclinical safety data
In common with other potent selective β2-agonists, salbutamol has been shown to be teratogenic in mice when given subcutaneously. In a reproductive study, 9.3% of fetuses were found to have cleft palate at 2.5mg/kg dose. In rats, treatment at the levels of 0.5, 2.32, 10.75 and 50mg/kg/day orally throughout pregnancy resulted in no significant fetal abnormalities. The only toxic effect was an increase in neonatal mortality at the highest dose level as the result of lack of maternal care. Reproductive studies in the rabbit at doses of 50mg/kg/day orally (i.e. much higher than the normal human dose) have shown fetuses with treatment related changes; these included open eyelids (ablepharia), secondary palate clefts (palatoschisis), changes in ossification of the frontal bones of the cranium (cranioschisis) and limb flexure. Reformulation of the Ventolin Evohaler has not altered the known toxicological profile of salbutamol.
The non-CFC propellant, HFA 134a, has been shown to have no toxic effect at very high vapour concentrations, far in excess of those likely to be experienced by patients, in a wide range of animal species exposed daily for periods of two years.
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Peak Flow doesn't always drop despite being symptomatic. 
Respiratory Consultant wants me to come off asthma meds!
Feelings about FeNo testing 
New to biologics - don't feel particularly well.
If my peak flow has always been low what will spirometry reveal?
