Just wondering how other asthma nurses/practitioners in general practice are managing the discontinuation of A+H's Becotide + Becloforte?
My pct have advised no special action at present and I am just advising pt's that they will probably get a different brand from their pharmacist. However, I'm not entirely convinced that all pt's will receive a device they are familiar with and am a little confused as to whether they should be transferred to non-cfc inhalers anyway, as surely the other manufacturer's cfc-devices will have to be discontinued as per the Montreal Treaty too at some point in the future?
I personally have started to prescribe by brand, as the pharmacies tend to be stocking CFC-free in preference to CFC inhalers now. You are correct in that all CFC inhalers will be being withdrawn gradually.
As I understand there are 2 main CFC-free brands - Clenil and Qvar. Qvar has a different bioavailability to the standard Becotide - i.e. it works out roughly twice the strength dose for dose - whereas Clenil is roughly equivalent. So someone on 2 puffs BD of becotide could go over to 2 puffs BD of Clenil or 1 puff BD of Qvar.
Qvar comes in autohaler and MDI, not sure about Clenil but it definitely comes as a standard MDI which will fit the Volumatic spacer. The Qvar MDI has a round end though, so you'd need an Able spacer.
Do warn the patients though - Clenil has a particularly strong taste and can ""catch"" the back of the throat - a bit like the old serevent inhalers. Spacers help with this.
Hope this is helpful to you.
CathBear
I work as a pharmacist for Boots, we have plenty of stock of both becotide and becloforte and as yet have had no problems getting stock of either, so our patients won't as yet be recieving a different brand. Most local surgeries are changing over to the cfc free and we also stock clenil and qvar...we prefer the new cfc-free inhalers to be prescibed by brand due to the dosage difference between clenil and qvar.
My surgery pharmacist sent a blanket letter out to all patients on becotide and becloforte to say they would be automatically changed to Qvar at the next prescription. The one problem with that is that Becloforte doesn't have an exact equivalent in Qvar as the dose needs to be halved. I reacted to Qvar when prescribed it previously so then panicked but GP changed me to Clenil after a few of phonecalls and an appointment. I have had a few problems with an intermittent pump failure for Clenil though with the first 3 inhalers although my current one seems fine.
Many thanks for your responses!
I initially started changing pt's onto branded cfc-free's (mainly Qvar as I don't have much knowledge yet re:Clenil) at the half-dose as advised but then stopped following the advice from my pct.
It's reassuring to hear that this is probably the best thing to do and I now plan to continue this approach but also find out more about the Clenil, too.
I find clenil more effective than becloforte. It matches becotide/becloforte dose for dose but it seems to be the 2nd choice for most GP's and pharmacists. I had to force myself not to cough when i first started on it but soon got used to it. It is a metered dose inhaler and is used with a spacer. There is an alternative method of administration but I can't remember what type of inhaler that was.
Its official...can no longer get Becotide in my pharmacy!...tried ordering some today but was told the manufacturer cannot supply.
Hi,
CathBear is right prescribing by brand.
Be careful because some practices are still prescribing Beclomethasone Extra Fine Particles which can equate different to Qvar or Clenil.
If a pt is on Becotide 100mcg they need either Qvar 50mcg or Clenil 100mcg. Its best all round now to prescribe by brand not generic.
Hope this helps.
Gavin
Our local pharmacy has also been very helpful regarding this - by keeping a record of which type of beclometasone the patient has been receiving, and ensuring that if they receive a generic beclometasone prescription then the same inhaler - either Clenil or Qvar - is dispensed each time.
I am hearing more and more about Clenil inhalers having intermittent pump failure. Perhaps not such a good idea for the unstable asthmatics.
On a personal level, I can't say that I've had any problems at all with the Clenil inhalers I've had - maybe I've just been lucky, but I have had quite a few since swapping from becotide.
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I just want to know, is it just me?
How would a rational person deal with this? What would be their thought process?
