Asthma Flare ups

Hi there

Just wondering if anyone else is experiencing the same problems with their asthma.

Over a year ago following my annual asthma review with my asthma nurse, i was prescribed Symbicort 200/6 2 puffs twice daily, on the SMART trial.

Previously i was on Ventolin 100mcg, Two puffs as and when required, Becotide 200mg, two puffs four times daily and Serevent 50 mcg, 2 puffs twice daily.

Since being switched to the symbicort, i have suffered numerous chest and upper respiratory infections. My asthma has not been very controlled.

I had to take a week off work, because i just couldn't breathe, or talk, as i was so breathless. It was terrible from the beginning of December, when we had that cold spell. My triggers are, dust, extremes of temperature, both too hot, or too cold, viruses, and common cold.

I work in a nursery, and Ofsted dictate that we have to do free flow, children can flow between being inside and outside, going from a warm nursery to outside in the cold, my asthma flares up, even if i take my ventolin 15-20 minutes before going outside this does not prevent an attack. I even wear a scarf round my mouth, so that i breathe in warmer air.

After a few months, I was prescribed ventolin to use as well as Symbicort, as i was having asthma attacks and having to rely on my symbicort to relieve the symptoms i was experiencing during exercise and every day activities...Basically i needed to prevent attacks rather than treating them when they happened.

My asthma was ok when i was taking the combination of all three inhalers, ventolin, Becotide and Serevent (Seperately).

I have been prescribed Prednisolone 4 times since December, because of asthma flare ups.

I have tried to get an appointment with the asthma nurse and she is fully booked till the end of March, however the receptionist noticed that my breathing was not right and remembered me being at the surgery xmas eve, and having to be nebulised...so she kindly got the doctor to phone me tonight, which he kindly has...

He has prescribed me Symbicort 400/12, Two puffs twice daily, got an appointment in 2 weeks time to see how i'm getting on...

I'm worried about the step up to the higher dose, does anyone have any problems/side effects from this dose?

Sorry to be waffling on, i've probably bored you all...

Hope to hear from you

Moschops

15 Replies

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  • hiya, hope you are feeling better, I take symbicort 400/12 because my asthma wasn't being controlled on seretide and I haven't had any side effects my asthma is also more controlled since starting symbicort.

    Lejaya

  • Go and ask for a referal to a specialist and please if you are so breathless you can't talk dial 999 not being talk is a sign of life threatening attack.

    If you are worried at anytime you can go to your local A&E they are not going to think you are being silly or not take you seriously they know how quickly asthma can become life threatening.

  • Re: Flare ups

    Thanks for your reply to my post, i'm hoping that my asthma starts to improve once the Symbicort 400/12 kicks in...

    I've never struggled this much with my asthma, even when i was diagnosed 15 years ago...

    Have a good weekend

    Moschops

  • I was on beclaforte 250 and serevent until the middle of last year as the nurse practioner was concerned at the amount of steroids I was taking. I was put on Symbicort 400/12, Montelukast 10mg and fluticasone 125mcg and my asthma is well controlled now.

  • Hi there

    did the dr not give you ventolin inhaler when he/she prescribed the symbicort???

    It seems very odd they didnt give you a releiver inhaler to use alongside the symbicort. Someone clever will tell me but i thought symbicort was a preventor with another medicine and thats where i get stuck is the additional medicine a protector or long acting releiver????

    Anyhow that doesnt really matter as you shouldnt have been using the symbicort to releive symptoms of acute asthma... thats what ventolin or bricanyl are for!!

    Your dr should have given you a ventolin inhaler either at the same time as the symbicort or before to see if this worked...

    Take care kat Xx

    (P.S - someone correct me if im wrong re-symbicort - its a long time since i had it and i cant really remember properly!! Ta guys n gals!!)

  • Kit-Kat - Formoterol, the long-acting component of symbicort, also has a licence as a ""reliever"" medication as its time to onset of action is so short. Under the SMART regime, you use the Symbicort inhaler as both your regular maintainence dosing and your reliever inhaler, up to 12 puffs per day total.

    HTH,

    CathBear

  • Hi.

    Please do not use the 400/12 as and when needed. It is NOT currently licensed for the SMART regime (or wasn't a few months ago). The dose for 200/6 is an absolute maximum of 12 if really bad - but even then you should also be thinking about whether you need to be seeing the doctor, you will be seriously overdosing on 12 puffs a day of 400/12. (I'm a SMART user and do some work in medical research) If you are not sure you could always ask the pharmacist who prescribed the drugs - they will know the current guidelines.

    Most surgeries will at least let you have a telephone appointment with you doctor to check things out. You might also need a reliever such as bricanyl or ventalin but again you will need to check with your doctor

    I really hope things improve for you soon.

  • hi smudge

    can you explain what the problem would be with taking over 12 puffs of the symbicort 200/6? I realise that if you are needing more and more puffs to control asthma, you should see a doctor, but i didn't realise that it could be a problem.

    thanks

    ekk

  • I'm not medically qualified so i may well be wrong but until someone more knowledgeable comes along... I don't think you are meant to take more than 12 doses of Symbicort 200/6 under the SMART regime - its like the maximum recommended dose. I guess in an emergency whilst waiting for help you could use more but i don't think its recommended that you use more than that otherwise. Hope this helps, take good care, Lois

  • OK now I am bit confused. My son who is 12 is on a maintenance dose of 4 puffs a day of Symbicort 400/12 and was told he could use up to an additional 4 puffs a day when he became breathless/wheezy. I am sure this would be over the maximum dose for 200/6 at 12 puffs a day. I should probably check it at his next appointment. He misunderstood there was a limit and when he was first told he could use extra and had 14 puffs at school one day! Must admit he didn't seem to have any side effects from it but a few eyebrows were raised when he told his consultant!

  • My Asthma was well controlled for a year But now I have gone back to my old self not able to do as much as I would like to I love cleaning and whilst asthma was under control I could go round the hole of my flat I even thought my asthma had gone from being brittle to mild I cant even get through one room at the min without stopping for nebuliser my con has given me 40mg pred to be taken for 5 days then reduce I have been on 40mg of pred for 10 days altogether then reduce for 5 days even been on high dose of steroids is still stopping me do basic things that I took for granted a year ago I just cannot except asthma has gone back to brittle suppose I had a whole year of not been in costa every 2 mins only went in twice last year and the year before that was mor like 15 times was in and i been admitted once this year and keeping fingers crossed thats the 1st and last time xxxxx

  • Symbicort 400/12 dosage

    Asthma

    Symbicort Turbohaler is not intended for the initial management of asthma. The dosage of the components of Symbicort is individual and should be adjusted to the severity of the disease. This should be considered not only when treatment with combination products is initiated but also when the maintenance dose is adjusted. If an individual patient should require a combination of doses other than those available in the combination inhaler, appropriate doses of beta2-agonists and/or corticosteroids by individual inhalers should be prescribed.

    Recommended doses:

    Adults (18 years and older): 1 inhalation twice daily. Some patients may require up to a maximum of 2 inhalations twice daily.

    Adolescents (12-17 years): 1 inhalation twice daily.

    Patients should be regularly reassessed by their prescriber/health care provider, so that the dosage of Symbicort remains optimal. The dose should be titrated to the lowest dose at which effective control of symptoms is maintained. When long-term control of symptoms is maintained with the lowest recommended dosage, then the next step could include a test of inhaled corticosteroid alone.

    In usual practice when control of symptoms is achieved with the twice daily regimen, titration to the lowest effective dose could include Symbicort given once daily, when in the opinion of the prescriber, a long-acting bronchodilator would be required to maintain control.

    Children (6 years and older): A lower strength is available for children 6-11 years.

    Symbicort 400/12 should be used as Symbicort maintenance therapy only. Lower strengths are available for the Symbicort maintenance and reliever therapy regimen.

  • Symbicort 200/6 dosage

    Symbicort Turbohaler is not intended for the initial management of asthma. The dosage of the components of Symbicort is individual and should be adjusted to the severity of the disease. This should be considered not only when treatment with combination products is initiated but also when the maintenance dose is adjusted. If an individual patient should require a combination of doses other than those available in the combination inhaler, appropriate doses of beta2-agonists and/or corticosteroids by individual inhalers should be prescribed.

    The dose should be titrated to the lowest dose at which effective control of symptoms is maintained. Patients should be regularly reassessed by their prescriber/health care provider so that the dosage of Symbicort remains optimal. When long-term control of symptoms is maintained with the lowest recommended dosage, then the next step could include a test of inhaled corticosteroid alone.

    For Symbicort there are two treatment approaches:

    A. Symbicort maintenance therapy: Symbicort is taken as regular maintenance treatment with a separate rapid-acting bronchodilator as rescue.

    B. Symbicort maintenance and reliever therapy: Symbicort is taken as regular maintenance treatment and as needed in response to symptoms.

    A. Symbicort maintenance therapy

    Patients should be advised to have their separate rapid-acting bronchodilator available for rescue use at all times.

    Recommended doses:

    Adults (18 years and older):1-2 inhalation twice daily. Some patients may require up to a maximum of 4 inhalations twice daily.

    Adolescents (12 – 17 years):1-2 inhalations twice daily.

    In usual practice when control of symptoms is achieved with the twice daily regimen, titration to the lowest effective dose could include Symbicort given once daily, when in the opinion of the prescriber, a long-acting bronchodilator would be required to maintain control.

    Increasing use of a separate rapid-acting bronchodilator indicates a worsening of the underlying condition and warrants a reassessment of the asthma therapy.

    Children (6 years and older): A lower strength is available for children 6-11 years.

    B. Symbicort maintenance and reliever therapy

    Patients take a daily maintenance dose of Symbicort and in addition take Symbicort as needed in response to symptoms. Patients should be advised to always have Symbicort available for rescue use.

    Symbicort maintenance and reliever therapy should especially be considered for patients with :

    • inadequate asthma control and in frequent need of reliever medication

    • asthma exacerbations in the past requiring medical intervention

    Close monitoring for dose-related adverse effects is needed in patients who frequently take high numbers of Symbicort as-needed inhalations.

    Recommended doses:

    Adults (18 years and older): The recommended maintenance dose is 2 inhalations per day, given either as one inhalation in the morning and evening or as 2 inhalations in either the morning or evening. For some patients a maintenance dose of 2 inhalations twice daily may be appropriate. Patients should take 1 additional inhalation as needed in response to symptoms. If symptoms persist after a few minutes, an additional inhalation should be taken. Not more than 6 inhalations should be taken on any single occasion.

    A total daily dose of more than 8 inhalations is not normally needed; however, a total daily dose of up to 12 inhalations could be used for a limited period. Patients using more than 8 inhalations daily should be strongly recommended to seek medical advice. They should be reassessed and their maintenance therapy should be reconsidered.

    Children and adolescents under 18 years: Symbicort maintenance and reliever therapy is not recommended for children and adolescents.

  • Hello Woody,

    Symbicort as part of the SMART programme can be used as a reliever up to a certain number of doses a day. It is also taken twice daily as a preventer.

    I am not up to speed on symbicort SMART so perhaps someone else who is on the programme could elaborate!

    Kate

  • OK. Symbicort SMART.

    Symbicort is a combination inhaler of budesonide (an inhaled corticosteroid) and formoteral (a beta-2 agonsist that has onset of action within 5 minutes and lasts up to 12 hours). It is available in three doseage combinations - 100/6, 200/6, and 400/12 (dose of budesonide/formoterol).

    Traditionally, Symbicort was used in exactly the same way as Seretide, another combination inhaler - i.e. as a preventative/protector medication, taken twice a day to prevent asthma symptoms. Patients would use a reliever/blue inhaler as usual if they experienced asthma symptoms during the day. Recently, because the formoterol component of Symbicort has such a short time-to-action, it gained a licence as a ""reliever"" medication.

    Symbicort SMART utilises the fact that increasing asthma symptoms reflect increasing inflammation in the lungs - so, by taking the Symbicort as a reliever inhaler through the day, it acts to treat the inflammation in the lungs should you need to use reliever medication. Usual reliever medications don't do this, they simply open the airways up without treating the inflammation - so people not on Symbicort will usually e.g. put up their inhaled steroid dose if they are getting persistent symptoms.

    The idea of Symbicort SMART is that you only have one inhaler, and use it for both preventative and reliever indications, as described above.

    HOWEVER - only the 100/6 and 200/6 inhalers are licenced to be used in this way. The 400/12 inhaler dose NOT have a licence for this (assumably because if you used up to 12 puffs of the 400/12 you would be massively overdosing on the formoterol component of the medication). The doseage indications are as follows: ""For relief of symptoms, 1 puff as needed up to max. 6 puffs at a time; max. 8 puffs daily; up to 12 puffs can be used for a limited time but medical assessment should be considered"".

    Clear as mud? Marvellous.

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