what else

im just wondering in other peoples experience what is the next stage i can have in meds really.

i am on currently seretide 125, salamol 100, cetrazine and nasofen aqueous

I have been told my 2 inhalers are not working for me and i need them changing when i see the asthma nurse but im not sure what else they can give me as i was very mild untill recently

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There is plenty more you can try, higher dose of seretide 250 or even 500, montelukast or zafirlukast tablets. Look up the British thoracic guidelines brit-thoracic.org.uk/clinic... The stepwise management in adults table is useful as a quick glance summary

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Thank you

I as i have no idea what is available for me i get stuck, and im just in the middle of changing gps as well as my old ones didnt know or help me much with my asthma i have no idea where i am or anything

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Good luck with new GP practice. Ask for an action plan if you've haven't got one-they're available on this website, look along the top under all about asthma and then publications at the bottom. As I said before, there is lots of options. You could have the Seretide increased, add in montelukast (one tablet a day)... Have copied this from the BNF (British National Formulary) for you, bnf.org/bnf/bnf/current/119...

Adult and Child over 5 years

Step 1: occasional relief bronchodilator

Inhaled short-acting beta2 agonist as required (up to once daily)

Note Move to step 2 if needed more than twice a week, or if night-time symptoms more than once a week, or if exacerbation in the last 2 years

Step 2: regular inhaled preventer therapy

Inhaled short-acting beta2 agonist as required

plus

Regular standard-dose(1) inhaled corticosteroid (alternatives(2) are considerably less effective)

Step 3: inhaled corticosteroid + long-acting inhaled beta2 agonist

Inhaled short-acting beta2 agonist as required

plus

Regular standard-dose(1) inhaled corticosteroid

plus

Regular inhaled long-acting beta2 agonist (salmeterol or formoterol)

If asthma not controlled

Increase dose of inhaled corticosteroid to upper end of standard dose range(1)

and

Either stop long-acting beta2 agonist if of no benefit

Or continue long-acting beta2 agonist if of some benefit

If asthma still not controlled and long-acting beta2 agonist stopped, add one of

Leukotriene receptor antagonist

Modified-release oral theophylline

Modified-release oral beta2 agonist; child under 12 years not recommended

Step 4: high-dose inhaled corticosteroid + regular bronchodilators

Inhaled short-acting beta2 agonist as required

with

Regular high-dose(3) inhaled corticosteroid

plus

Inhaled long-acting beta2 agonist

plus

In adults 6-week sequential therapeutic trial of one or more of

Leukotriene receptor antagonist

Modified-release oral theophylline

Modified-release oral beta2 agonist

Step 5: regular corticosteroid tablets

Refer to a respiratory specialist

Inhaled short-acting beta2 agonist as required

with

Regular high-dose(3) inhaled corticosteroid

and

One or more long-acting bronchodilators (see step 4)

plus

Regular prednisolone tablets (as single daily dose)

Note In addition to regular prednisolone, continue high-dose inhaled corticosteroid (in exceptional cases may exceed licensed doses); these patients should normally be referred to an asthma clinic

Stepping down

Review treatment every 3 months; if control achieved, stepwise reduction may be possible; reduce dose of inhaled corticosteroid slowly (consider reduction every 3 months, decreasing dose by up to 50% each time)

(1)Standard-dose inhaled corticosteroids

Beclometasone dipropionate or budesonide 100–400 micrograms twice daily; child under 12 years 100–200 micrograms twice daily

Fluticasone propionate 50–200 micrograms twice daily; child 4–12 years 50–100 micrograms twice daily

Mometasone furoate 200 micrograms twice daily

Note. Dose adjustments may be required for some inhaler devices, see under individual preparations, section 3.2

(2)Alternatives to inhaled corticosteroid are leukotriene receptor antagonists, theophylline, inhaled cromoglicate, or inhaled nedocromil

(3)High-dose inhaled corticosteroids

Beclometasone dipropionate or budesonide 0.4–1 mg twice daily; child 5–12 years 200–400 micrograms twice daily

Fluticasone propionate 200–500 micrograms twice daily; child 5–12 years 100–200 micrograms twice daily

Mometasone furoate 200–400 micrograms twice daily