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Ban of CFC Beclometasone inhalers - clenil modulite, salmeterol.

Asthma sufferers uch as myself will know this inhaler as 'the brown one' - the one with the steroids. I have been using a similar inhaler to this all my life - usage being twice in the morning and twice at night.

However, I was recently pescribed a new inhaler on my repeat pescription (clenil modulite) due to the fact the beclometasone has been discontinued due to the CFCs in it apparently.

I gave the new clenil modulite inhaler a chance, although it was difficult even though the modulite made by an alternate company was packaged in much the same way the beclometasone and the becotide were before that. however it is in the usage of the clenil modulite that was too strong for my system and i often gagged whilst using it. The modulite seemed to also expel more liquid in usage that also has a unique fragrance - all these qualities were exempt in teh usage of the beclometasone.

So I complained about the clenil modulite and was pescribed a steroid free alternative - salmeterol xinofoate - this time packaged in an attractive 'off green'. I tried this, and I dont know if it was a result of the lack of steroid in an inhaler i was using after using an inhaler with steroid in it all my life, but my throat began to dry and sore during the weeks which i tried using it and I felt bloated as if my metabolism was affected.

I have since stopped using the salmeterol over the christmas and new year period of excess where stability of my asthma (as all asthma sufferers know) was needed.

My asthma is currently under control because I'm using the dreggs of two beclometasone inhalers I have left over, however these will soon run out.

has anyone else encountered this problem?

20 Replies
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A CFC free version of beclometasone is available - I was put on the Qvar brown inhaler to rplace the CFC brown inhaler

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Have bumped up the 'New inhalers, I'm confused, can anyone enlighten me?' thread.

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Clenil is quite disgusting, so it's not advisible to try and take it without a spacer - this helps reduce (or eliminate) both of the problems you had with it. Ask your GP/asthma nurse to prescribe you a Volumatic spacer.

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Clenil Modulite and Beclometasone Dipropionate are the same item. Just one is the generic name and the other chemical name. I was on this originally when diagnosed with asthma, and found it gave me a sore throat, the use of a spacer, regardless of dosage is what I discovered the best way to prevent this.

The difference you notice, is more likely to be the change in propellant. I can't comment on this as I've not use a CFC inhaler.

Salmeterol, is not a steroid replacement, but an addition to the inhaled steriods, its a long acting bronchial dilator (I used that as well), and it must not be used without the addition of the steroid inhaler (serious side effects have been reported in these cases - increased death rates)

I now use seretide, which is a combination of a steroid and salmeterol, much better, still use the spacer, but don't get the sore throat the same, less items to inhale I guess.

Please read the precautions below for salmeterol/serevent - taken from the prescribing notes issued to doctors.

4.4 Special warnings and precautions for use To the top of the page

The management of asthma should normally follow a stepwise programme and patient response should be monitored clinically and by lung function tests.

Salmeterol should not be used (and is not sufficient) as the first treatment for asthma.

Salmeterol is not a replacement for oral or inhaled corticosteroids. Its use is complementary to them. Patients must be warned not to stop steroid therapy and not to reduce it without medical advice even if they feel better on salmeterol.

Salmeterol should not be used to treat acute asthma symptoms for which a fast and short-acting inhaled bronchodilator is required. Patients should be advised to have their medicinal product to be used for the relief of acute asthma symptoms available at all times.

Increasing use of short-acting bronchodilators to relieve asthma symptoms indicates deterioration of asthma control. The patient should be instructed to seek medical advice if short-acting relief bronchodilator treatment becomes less effective or more inhalations than usual are required. In this situation the patient should be assessed and consideration given to the need for increased anti-inflammatory therapy (e.g. higher doses of inhaled corticosteroid or a course of oral corticosteroid). Severe exacerbations of asthma must be treated in the normal way.

Although Serevent may be introduced as add-on therapy when inhaled corticosteroids do not provide adequate control of asthma symptoms, patients should not be initiated on Serevent during an acute severe asthma exacerbation, or if they have significantly worsening or acutely deteriorating asthma.

Serious asthma-related adverse events and exacerbations may occur during treatment with Serevent. Patients should be asked to continue treatment but to seek medical advice if asthma symptoms remain uncontrolled or worsen after initiation on Serevent.

Sudden and progressive deterioration in control of asthma is potentially life-threatening and the patient should undergo urgent medical assessment. Consideration should be given to increasing corticosteroid therapy. Under these circumstances daily peak flow monitoring may be advisable. For maintenance treatment of asthma salmeterol should be given in combination with inhaled or oral corticosteroids. Long-acting bronchodilators should not be the only or the main treatment in maintenance asthma therapy (see Section 4.1).

Once asthma symptoms are controlled, consideration may be given to gradually reducing the dose of Serevent. Regular review of patients as treatment is stepped down is important. The lowest effective dose of Serevent should be used.

Salmeterol should be administered with caution in patients with thyrotoxicosis.

There have been very rare reports of increases in blood glucose levels (see Section 4.8) and this should be considered when prescribing to patients with a history of diabetes mellitus.

Cardiovascular effects, such as increases in systolic blood pressure and heart rate, may occasionally be seen with all sympathomimetic drugs, especially at higher than therapeutic doses. For this reason, salmeterol should be used with caution in patients with pre-existing cardiovascular disease.

Potentially serious hypokalaemia may result from β2 agonist therapy. Particular caution is advised in acute severe asthma as this effect may be potentiated by hypoxia and by concomitant treatment with xanthine derivatives, steroids and diuretics. Serum potassium levels should be monitored in such situations.

Data from a large clinical trial (the Salmeterol Multi-Center Asthma Research Trial, SMART) suggested African-American patients were at increased risk of serious respiratory-related events or deaths when using salmeterol compared with placebo (see section 5.1). It is not known if this was due to pharmacogenetic or other factors. Patients of black African or Afro-Caribbean ancestry should therefore be asked to continue treatment but to seek medical advice if asthma symptoms remained uncontrolled or worsen whilst using Serevent.

Patients should be instructed in the proper use of their inhaler and their technique checked to ensure optimum delivery of the inhaled medicinal product to the lungs.

As systemic absorption is largely through the lungs, the use of a spacer plus metered dose inhaler may vary the delivery to the lungs. It should be noted that this could potentially lead to an increase in the risk of systemic adverse effects so that dose adjustment may be necessary.

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A couple of years ago my GP tried me on Clenil but I found the propellant gave me an ongoing cough - I gather many people don't 'get on' with it for various reasons.

I returned to my GP - who is exceptionally rational, good at listening and takes notice of my input - who gladly tried me on other steroid inhalers, one of which now works brilliantly.

The most logical step, surely, is to return to your GP and see whether they're prepared to trial you on other steroid inhalers.

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i cannot use any aerosol inhalers so i use accuhalers these are dry powder ones.

There is just something in aerosols that trigger my asthma still not found out what. Try asking asthma nurse for a different style inhaler device.

plumie

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Hello,

Can I just mention that Serevent, is steroid free it is recomended that you use a steroid preventer as well. It should not be called an alternative to steroid inhalers.

There were a few problems some years ago when serevent came out - people assumed as it was a protector that it did the same thing as steroids. It is a long acting bronchodilator but it doesn't reduce the inflamation that steroids do.

That is why it was combined with flixotide to make seretide which is a more patient compliant inhaler.

There are also many other steroid inhalers available and not just the beclomethasone based ones. Please ask your GP or asthma nurse.

Also I though all the CFC inhalers had gone by now..... someone must have been squirreling them away somewhere in the pharmacy world...

Kate

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hi

i also gave the new clenil modulite inhaler a chance but it really is yuck even with a aerochamber (i cant cope without the aerochamber which is why i only have brown aerosole ones for home use. i have turbohaler relievers!!!!) if anything i felt like my asthma was worse!

i to have been copeing on what i have left of the old beclametasone inhalers. i have also some how managed to obtain two different prescriptions one has all my normal inhalers ect on as well as the old beclametasone and the other again has all my normal inhalers ect on as well as the new clenil modulite inhaler. so i was usisng the old prescription and also trying different pharmacies in the local area to try to get the old beclametasone inhaler as surely they will still dispense it if they have stock of it ?

but i to will be faced with the situation of having to take the new clenil modulite soon, and was glad to see your psot and peoples advice

thanks xx

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so, just to sum up;

A) no one likes the clenil modulite and I'm not a singular case where this is aggravating my condition rather than being a healthy substitute for the beclometasone.

B) the servent/salmeterol shouldnt have been pescribed to me as it has no steroid trace in it and i should still have at least one inhaler with steroid trace in it.

- so i ask again, what should I ask for - should i ask to speak to the asthma nurse?

- Has anyone had the same experience as me and gone on to be pescribed an inhaler substitute (other than the clenil and serevent) that worked for them?

+ I'd like to ask everyone again, if they've any info on how inhalers effect the metabolism e.g. when i tried the nonsteroid serevent instead of the beclometasone and the clenil it made me feel bloated, and my heart beated rapidly (noticably).

thanks

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The Asthma UK CFC-free inhalers factfile contains information on the change to the new CFC-free steroid inhalers. It can be found by following the link below and contains useful answers to frequently asked questions. The advice on page 3 is to see your doctor or asthma nurse for a follow up appointment if you're not happy with your new inhaler in order to find a device and medicine that suits you best.

tinyurl.com/9b6tr6

(This points to

asthma.org.uk/all_about_ast...

Click on the weblink under 'Useful Materials' in lilac box on the right hand side of the screen to open a 69kb Adobe Acrobat file.

I've used Becotide before but not Clenil so can't comment on differences in taste propellant-wise!

amszephyr has posted below on 11 Jan 09 with a similar experience.

I guess that it would also be sensible to discuss any side effects experienced while using Serevent with your doctor or asthma nurse.

Hope that helps.

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the url is wrong and said page missing.

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Sorry about that - the forum software is a bit quirky and has added a space between the two lines separating the URL.

I've re-posted the URL using a shortened TinyURL link:

tinyurl.com/9b6tr6

Or try copy and pasting again and *deleting* the space between the 'e' and 's' in

""medicine s_treatments/switching_to.html"" in the URL.

*Alternatively* navigate by:

1. Moving your mouse or touchpad pointer to the 'All about asthma' link in the green horizontal bar above to reveal the drop down menu.

2. Select 'Medicines and treatments'.

3. Then select the 'Switching to CFC-free inhalers' link in purple letters on the left.

This is the page referenced by the URL.

4. Then click on the link 'CFC-free factfile' under 'Useful Materials' in the lilac box on the right hand side of the screen to open the 69kb pdf file.

Hope that works! What really matters though is that you find a suitable alternative to the CFC Beclometasone that works for you, and that you can get on with. If Clenil is still difficult to tolerate with a spacer, then there are other alternatives to try. As well as Clenil and Qvar, there are dry powder inhalers containing beclometasone, as well as MDI and powder inhalers containing other preventers. Your GP or asthma nurse would be the best person to discuss this with as they will give advice based on your medical history.

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I had a go on theTurbohaler inhalation Powder and it didnt work for me and caused thrush on my tongue, noe back on Seretide evohaler but still got the thrush after 11 months!!!!

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*latest news* - went to see asthma nurse, said I had problems with clenil and serevent/salmeterol and 'she' pescribed me QVAR something most people are pescribed after going the route I've mentioned. The servent shouldnt be considered a replacement for the beclometosone as it has not steroid trace and should be seen as more of an 'add on' apparently to be used alongside the steroid inhalers when asthma is at its worst. QVAR is another direct substitute for the beclometosone like clenil but made by a different company, therefore a diferent 'propellent'. Hopefully it worksout!

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Hi

I've recently changed to Clenil Modulite after taking my previous CFC Brown inhaler for a number of years with no difficulties.

Agree with the very odd taste - do take via a spacer devise - whilst also experiencing worsening of symptoms.

Joules

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As a specialist nurse, can I please make a plea folks?

Please, regardless of the colour/drug, would you always use the puffer (MDI) with a spacer of some kind as:

a) it will not tastes as bad

b) as it comes out at 75 miles an hour it will make your throat sore &

c) most people cannot co-ordinate good enough to get more than about 4% of the microgram dose you squirt in, particularly when you are having a bad attack

If you do not want to use a spacer there are plenty of devices out there that you dont need a spacer for which your practice nurse should sort out for you at your next check up. You will benifit in the long run.

Thanks

A

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Symbicort tastes really ucky if you don't breathe it in properly. If nothing else, this is a great reminder to gargle immediately after taking and to brush the teeth.

I'm not bothered either way, but the 'twist the base' action is easier than the 'press & breathe' variety.

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Hello,

I've been using the Clenil inhaler for a few months and while it does taste odd, I have found that using my spacer really helps and leaving five minutes between puffs means I don't find my chest tickling or stinging as much. I also gargle after each time as I've noticed that I lose my voice with it too.

I know that what works for one person might not be any use to another, but perhaps those two measures together might improve the situation. While I don't like the fact that when my chest is sensitive the clenil makes me want to cough, I personally have found it the most effective treatment thus far and the benefits outweigh the annoyance.

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Hi there I use the clenil modulate 100mg inhaler 4 puffs twice a day (brown inhaler) and the Salmeterol 25mg inhaler (green inhaler) 2 puffs twice a day. And I also gag when using clenil so I know have to take the inhaler through the spacer. I can take the Salmeterol with out the spacer but don't as I have found that when I take it without the spacer I get a horrid sore throat even with my mouth-wash routine after my inhalers but with using the spacer I don't get the sore throat. I have also been informed by my dentist that it is best to take the inhalers through a spacer anyway as less of the steriod this way gets contact with your teeth and gums as you control the pace the medication gets into your lungs. I have far less problems with soreness in my mouth as well and feel my oral care is far better since using the spacer for my inhalers as I don't seem to be getting the steriod burns inside my mouth.

My son is also on the clenil modulate 100mg inhaler 2 puffs twice a day at present and he also starting taking his without a spacer and got the sores in his mouth but know he is re-using the spacer the sores have gone and no more sores have formed. I would try the clenil again but ask for a spacer and try it through that and see if there is any difference.

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I haven't noticed a difference since moving from the CFC brown inhaler to the Qvar one. I use all my inhalers through my spacer unless I'm out & I have an attack, then it's only the reliever.

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