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Does this seem right? Symbicort to replace clenil/vent...

I saw my asthma nurse on Monday as I've been on clenil (2 x 200 twice a day) and vent for a few months. I mentioned that I was still symptomatic albeit mildly and my peakflows are at the low end of the green range. As I am newly pregnant and desperate to have a better winter than the last 2 I thought I would chat to her.

She suggested I try symbicort and explained how it worked, fine, I'm happy with that but...

She's prescribed the 100/6 dose saying to take 1 twice a day and up to 8 times inbetween if needed on top.

At the time I was thinking ok fine but I've just read that it's the lowest dose available and i'm wondering if she meant to prescribe the lowest...

She'd just come back from Austrailia that morning and admitted herself she was knackered/jet lagged...

I mean, at least it wasn't a stupidly high dose accidently but seeing as I was on a highish dose of the clenil, it seems a bit wierd to go to lowest dose of symbicort...

Can anyone offer any advice/got any experience with this?

6 Replies
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Am i right in thinking clenil is just a steroid inhaler? Because symbicort is a steroid and long lasting reliever (12hrs) inhaler. Also, 4 puffs a day of clenil is 800mcg steroid and if you used the max of 10 puffs of symbicort you would be having 1000mcg a day. Its also good because the worse your symptoms the more meds you take and when things calm down your meds dosage also calms down without you having to think about it.

Good luck with it anyway!

Jac

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Hi, yes clenil is just steroid. I get the theory of it and agree but as my asthma wasn't fully controlled on the clenil at 800 a day surely i'll end up needing to use a lot of it to get the same effect.

I was using the ventolin daily on the clenil, surely once the clenil is fully out of my system (only had this for 2 days) i'll end up needing to take more puffs a day to get the similar effect... I'm confused..

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I'm not very familiar with symbicort SMART but it does seem a little odd to reduce the steroid when asthma is not well controlled. Normally when a long acting beta agonist is trialled it's added on without changing the steroid dose, but symbicort SMART is a special case and I'm not sure how it's supposed to be introduced. I'd either ask the prescribing asthma nurse for some clarification, call the asthmaUK nurses on 08001216244 or try talking to a pharmacist (if you ask for a medicines use review they sit down with you and take a look at all your meds and have a chat about how well they're working for you and how appropriate they are).

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I have been/am sort of on the SMART system. It's normally best and the norm to start at a lower dose because you'll be getting added benefeit from the long acting reliever, meaning you may not necessarily need that extra steroid. Also you may be taking it through the day too.

Symbicort was a fab drug for me, hope it works for you!

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Hi, it would be worth checking out with your nurse or the AUK nurses about this. There is inconclusive evidence about the equivalence of the two types of steroids involved. A small study in New Zealand suggested that the steroid in symbicort was less potent but that has not been confirmed in larger studies. Of course the key indicators are your symptoms. I've changed over from clenil (100 x8 puffs daily) and serevent (4 puffs daily) to symbicort 200/6 (4 puffs daily). So far I haven't noticed any change in my symptoms - still get a bit breathless and feel a bit off. The big plus is not having so many puffs or having to use a spacer plus I haven't had all the side effects I got with seretide. Hope it works for you. Sonja

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Hi

First, congratulations on your new pregnancy!

Ok, here goes: Clenil Modulite contains the steroid beclamethasone. In Symbicort, there is a different steroid called budesonide. It is generally agreed that budesonide is a more potent/stronger steroid, gram for gram, than beclamethasone. So in fact (though I don't know for certain) you ""may"" be getting the same equivalent amount of steroid from your Symbicort.

Also, because the Symbicort contains formeterol - the long-acting reliever part - this may decrease your need for steroids. However, you must NEVER take a long-acting reliever without a steroid inhaler. As you have been put on the lowest dose, there is scope to increase if necessary.

Formoterol acts instantly, like ventolin, hence you can use this inhaler instead of ventolin (if that's what you've been instructed to do), giving you more steroid dosage if you need more reliever for symptoms in order to reduce them.

I hope this makes sense, if you have any questions feel free to PM me

Emz x

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