Problem with DuoResp Spiromax inhaler

Hello. I'm new to this forum. I have been asthmatic since I was five (I'm now 50) and have taken all sorts of inhalers with all sorts of delivery mechanisms. Last week I was prescirbed a DuoResp Spiromax inhaler. I usually have Symbicort but apparently this is the same drug but cheaper for my surgery (which has gone over its drugs budget).

The delivery mechanism is different than Symbicort but I took advice from the pharmacist and thought it wouldn't be a problem. However, every time I take the inhaler I start coughing and wheezing and this triggers my asthma. So basically it's not doing what it's supposed to do. I seem to be sensitive to the powder in the inhaler which doesn't seem to in suspension like Symbicort. I could be wrong but this is how if feels to me.

Has anyone else has this problem?

45 Replies

  • Hi JennyA I'm so pleased I found your thread... yes I am having exactly the same problem I used to use the symbicort inhaler and now my surgery last week swopped me to the duoResp spiromax and has made my ashima worse !I cough all the time and the powder sticks in my mouth! even though I rinse after use. I now have oral thrush!! The suspension seems very gritty and I'm not convinced its getting down to my lungs!! I will be going to have a talk with the pharmacist today! and see what they have to say? Thanks

  • It could be the propellant used in the duoResp Spiromax that is causing irritation making you cough and wheeze. I know if I take the airomir salbutamol it makes me cough and wheeze due to the propellant. If you are getting symptomatic with the new inhaler they have given you even if the practice are over budget they need to go back to giving you Symbicort.

  • Your post DaveRetro is really interesting and also makes me feel vindicated, Also interesting to here what you say justTux. I also find the powder often lands on my tongue and I'm not convinced it's all going into my lungs. I have written to my surgery but received no response. I don't like to be pushy or demanding but I am struggling. I am a brittle asthmatic so exacerbate very quickly and severely so I can't really take any chances. I know people on this site will understand what this is like. I think because I've had asthma since childhood though, I tend to be a little bit casual about my asthma but my family are pushing me to do something about this.

  • Some of the powder is supposed to land on your tongue to confirm you have had the dose. the medicine is inhaled into the lungs and the powder it is held in lands on your tongue so you know you've had your dose - that's what my pharmacist told me

  • JennyA,

    If you a brittle asthmatic you should be under the care of a specialist consultant at a hospital and your GP should be going no were near your asthma medications and changing things even if it for a cheaper one. In brittle Asthmatics everything has to be done through a consultant and the GP needs to stick with what the consultant prescribes not what the GP thinks you need. I know you don't want to make a fuss but sometimes you have to to ensure your health is ok!

  • I used to be a patient at the Brompton but was discharged years ago. My partner really wants me to be seen by a consultant at a centre of excellence rather than at the surgery. I don't even see the GP but an asthma nurse. She's great - very informed and caring - but my family and I feel that I may need a proper review. You've made me realise it's not me making a fuss but getting what I need.

  • Hi I too am having problems which I am pretty sure are from being changed from Symbicort to duoresp spiromax. I have problems coughing and sore throat but the worst thing of all are large red patches of my skin which also cover with hives this can occur anywhere on my body and the itch is unbearable. I have been going to see my GP since January with this problem and have been given a few different medications. Over the weekend again covered in hives the only thing I could put this down to was this had all started since being changed to duoresp spiromax so for 2 days did not take it and yes no hives. Went to see GP again who said take it again and see what happens 2 doses later been up all night with hives on legs and hands back to GP who has prescribed Symbicrt again I so hope this works time will tell.

  • I am itching like mad - all over my body - it feels like things are crawling all over me - is that the same as you?

  • Hope they sort it out for you soon Terry47. I ended up going to the doctor at the weekend as things got bad and I've been to my GP this week again. My records say they have taken me off the DuoResp and back on to Symbicort but I'm disappointed that no one responded to my email and told me this would happen.

  • HI, Sorry some of you are having problems still, Just to say that I went back to the doctors surgery and saw the main Asthma Nurse who also is the Practice Manager!! and explained about the problems with duoresp spiromax..she knew nothing about it!! and she wasnt very happy at all !! as the dosage amount and strength was LOWER than prescribed Symbicort! and I showed her the powder test where you tap out the two powders and feel them betweem your fingers! the duoresp spiromax was very gritty and she wasnt convince it wouldnt inhale properly also as there no propellant just inhalation! so it's not going where its meant to go into your lungs!... but getting stuck in mouth and throat hence Oral candita and severe Cough! and she also checked the Costing compered with Symbicort... which was very interesting!!!! anyway she said to make sure your repeat prescriptions have ""Symbicort"" written on them and not the just the drug name!

    Anyway I'm now back on the Symbicort, I feel better and the cough along with the other problem has now gone!

    So Please go back to the Doctors and demand to be put back on the ""Symbicort"" as its only a cost cutting ploy giving you the cheaper generic drug ""duoresp spiromax"" and it could affect you health!!!!

    Good luck Guys.

  • Glad you've sorted this out Dave. I am also back on the Symbicort. It makes me cross that we have a chronic, life-threatening condition but are used as guinea pigs. This is not the first time in my life this has happened All the things you say about DuoResp are exactly what I feel. The GPs may not believe us as there don't seem to be any papers or reports on this issue but as Carl Sagan said: 'Absence of evidence isn't evidence of absence'. Or something like that anyway. :-) Healthy days everyone.

  • Thought I'd update you on this issue. I contacted Teva , the company who make the inhaler, and am going to fill out a report. We shall see....

  • Good on ya i'm thinking I will do the same :-) x

  • Hi all. I was also put onto Spiromax with no warning, and immediately wasn't happy with it, as it was horribly powdery, and I was constantly slightly wheezy no matter how much I took! Luckily, I still had some Symbicort left, so just used that instead.

    I saw my Asthma nurse today and she said that she has had other reports of people not being happy with the inhaler (mainly for other drugs, but the same propellant, etc). Needless to say I'm back on Symbicort, but I was very annoyed by the pharmacy just changing with no warning. I'm going on holiday to the USA for a month soon, so what if I had picked these up the day before I went?

    JennyA - I'd be interested to know how you did a report to TEVA. I had a look on their website, but I can only report a side effect. Mind you, surely the drugs not working is a side effect!

  • Ditto -went to the chemists who forced this on me - vile powdery taste and nobody had informed my hospital clinic! Back to Symbicort. Who makes these decisions without consultation?

  • Just to up date - I have yellow carded the product at MHRA - cannot believe that it has taken me so long to control my symptoms just to be let down by a switch of medicine - my hospital has notified CCGs and pharmacists about this problem. Not sure of other forums that we could contact?

  • Out of interest, have any of you actually reported what is going on with these inhalers to the .asthma UK main office?

  • The name TEVA caught my eye! I had problems with them concerning another medicine Sertraline Hydrochloride. I previously took LUSTRAL but got changed to generic when NHS cost cutting commenced! Appears TEVA are a lot cheaper but not necessarily as good quality as the brands. I would never take any drug manufactured by TEVA again!

  • Hi all,

    Having used Symbicort 200/6, together with other medications, for a number of years, my COPD/Asthma was pretty much under control, the odd bad night but nothing serious. Last Friday I went to the chemist to collect my Symbicort to find it substituted with Duoresp 160 / 4.5, whilst the numbers are different both Symbicort and Duoresp deliver the same 160/4.5 dose so, in theory no problem. However since starting the Duoresp my breathing has gone seriously down hill with a really bad time on Sunday night when I couldn't stop an 'Asthma cough' until I seriously filled up on Ventolin. I've had to go from two pillows, sleeping on my side back to three pillows, sleeping propped up on my back. This morning I was hugely breathless and I feel so tired.

    The delivered dose is the same, I have no idea of the formulation but the base design seems flawed. When I put the mouthpiece in the cap is pushing against my chin thereby not letting me angle delivery properly with the result the dose is delivered to the back of my tongue rather than down my airways. I'm all for saving the NHS money but not if it results in my condition worsening like this.

  • I have read most of the concern expressed here of this drug duoResp Spiromax, prescribed by GP's in place of Symbicort and i too developed a severe reaction to this and the GP says they are unable to prescribe Symbicort by brand name and can only prescribe the generic version. I have complained to the pharmaceutical TEVA and they have asked me to return this item to the Pharmacy and they would arrange refund via the pharmacy. I have also initiated a complaint to NHS, about the doctors refusal to prescribe Symbicort by brand name despite telling them of the reaction i had to this drug. It is important to complaint direct to NHS for them to instruct the GP to prescribe medication that agree with you. Too much emphasis being placed on cost saving rather than treating individuals illness.

    I am still waiting for the NHS to respond, in the mean time received a questionnaire from the pharmaceutical TEVA.

    Judging from the number of complaints about this drug on Google, there are lot of us in the same situation.


  • Hello Mohan. That's so interesting. There clearly is an issue with DuoResp. Years ago, I was put on an asthma drug that made me feel acutely paranoid. I thought I was having a nervous breakdown. I found out eventually that doctors were being given incentives to promote the drug despite its not being that effective and having very bad side effects. Since then I have often felt like a guinea pig. I realise that doctors have very hard decisions to make but I feel they should listen to what we the users are saying. I absolutely and unequivocally support the NHS and would never take advantage but I am much more a burden to the system if I'm ill because of cost cutting.

  • I was only on duoresp for 1month, but I had the sore throat, really bad headaches, wheezing all the time which in general made me feel very unwell. I am also diabetic with angina. The GP tried to argue with me, telling me that I was wrong when I said that in the leaflet that came with duoresp it read- I shouldn't use this medication if I was diabetic. Now back on symbicort (3days) already feel better and no headaches or wheeze, yippee

  • Hi I have had the same problem, they changed my symbicort last month without warning, I have felt more wheezy but did not think it could be the inhaler. I went to pick my new prescription up this evening and asked the pharmacist if they had included symbicort instead of the new inhaler, she looked and said you should have symbicort and not any other. She told me to stop using the spiromax straight away and return it to them

  • I've only been given this today and I'm very worried bout taking this

    then I read this and I'm like....great nice one lol

    I'm 36 and have emphysema level 3

    I've been on the easy breeze powder but have still been gasping for breath (like I can't fill my lungs up enough to satisfy my need for I'm huffing all the time) spoke to nurse on phone and she sed to start this immediately as I sounded breathless on phone. I'm scared also prone to thrush on any thing that says it's a side affect

    I'm in a right to here but hope someone can guild me.

    only diagnosed beginning of December it's inherited so I av club finger too.

    by the lou 😊

  • So so pleased too to have found this feed. Been on at Symbicort for 8yrs and after years of severe asthma finally had become so well with it I would forget I had asthma unless extreme weather of illness came along. I got down to taking one puff a day off my 200/6 inhaler and after a change forced on me 3yrs ago went back to it after a week. Until my last review a month a go encouraged by my asthma nurse to go on duoresp and she assured me it was same drug but diffrent method of delivery. Well it isn't! For one in the last two weeks since starting I have had three asthma attacks and feel tired all the time, have to use the inhaler twice a day along with my salbutamol which I haven't used in years. It does have a off taste too. Then I noticed it's not even the same dose being 160/4.5.....I am contacting my GP surgery tomorrow to change back asap! never changing again after researching and discovering it's 21% cheaper than Symbicort which I sadly feel is the real reason I was encouraged to change .

  • Interesting thread. I was changed three months ago to the spiromax and haven't had a decents nights sleep since. I am horribly restless (usually a very sound sleeper), but the worst thing is that I become terribly dizzy when running up to the time I usually take my inhaler. It feels something like mild withdrawal symptoms. Has anyone else experianced these symptoms?

  • Hi,

    I've been using symbicort for a number of years and my asthma nurse has, this week, switched me to the duoresp. I was told that everyone in practice is being switched but wasn't given a reason why (I work for a CCG so I'm not without a certain amount of knowledge about prices of medications, especially mine, so I was happy to give the new one a go). I picked up my new inhalors last night and was given the guided tour by the pharmacist. I dutifully used the duoresp last night and when I awoke this morning I felt that I needed to use it again which is unusual for me because I had got down to one puff at night on the symbicort. Bring on the really bad headache! Anyway, I got into work and took some paracetamol and thought nothing more. As the day has progressed my headache has come back, I now have a sore throat, a dry catching cough and a far away wheeze which I cannot shift.

    The nurse also insited I have a ventolin which is strange because I haven't needed a reliever for over 5 years on the symbicort. Just had a go of the ventolin and the wheeze has almost gone.

    I think I am going to keep an asthma diary for the next few weeks so that I can evidence my symptoms when I go back.

    Apologies for the long post

  • I have had exactly the same reaction to Duoresp inhaler. Asthmatic since I was about 19, now 41, like you tried many inhalers, found symbicort to be excellent. My surgery also changed due to budget and I had an awful reaction, wheezing, tight chest, lost my voice etc. Worse than no inhaler. I called my gp and the dr changed me straight back to symbicort.

    i think its the propellant that's the issue in duoresp. Back on symbicort now and no wheezing chest, and my voice is starting to come back.

    If you are stable and in control on an inhaler they should not change it surely?? I won't again!

  • Hiya, I've had the same problem and I spoke with my MP to get a resolution because the doctors wouldn't give me Symbicort again because of cost cutting measures. Anyways the nurse was lovely and she kicked off and made site only get Symbicort. He is going to raise this but has asked we all contact our surgeries and lobby them to not put our health at risk to save money. Also we need to put our foot down with pharmacy and demand we get the product we started with. I'm from near Wakefield, where is everyone else from? Is this a northern thing to cut our meds?

  • Oh and I have contacted asthma uk, maybe more of us should

  • I've been out in duo resp in October. I find it easier to take, but find its very gritty in my mouth. Over the past few weeks I've had the start of a cold, that's not come out, and been really wheezy. After some reasewrch it seems that duo resp and symbisrt cortex aren't the same dosage. I've been taking ventolin to try to help the wheeziness, that I've only had to take when I've been really poorly.

    Today, I told the decision to ask being put back on symbicort and my asthma nurse was fine with it. Said I was the 1st one to comment on it. I've taken my symbicort tonight and it's make a difference. Hoping the lost/ raspy voice disappears. 

  • Hi JennyA

    I've been on DuoResp since October and I haven't exactly had your problem. However, I have been looking very carefully on how to do things because it was new for me as well. I notice that sometimes when I am in a hurry and inhale too quickly or too strongly, I start coughing as well.

    Also, I can clearly see that the newer the inhaler is (the more doses it has) that stronger and somewhat rougher the powder seems to be. Let's say I feel the first 50 doses much stronger than the rest. So maybe people should watch for that too - how hard it affects you with the different doses.

    One more thing - in my country actually the Symbicort is cheaper than the DuoResp... I don't know why. But from what I see from everyone's comment, it seems to me that maybe I've had your symptoms at first too but I was in a very poor condition then so maybe I thought it all part of the process. A month after I started it, however, I began getting better and almost have had no problems since then.


  • Like others here I am relieved to have found this link. I was started on Duoresp several weeks ago as the seretide wasn't controlling my symptoms. The nurse told me not to use my ventolin as my reliever- only the Duoresp and it has made my cough and wheeze worse instead of better. Like others I have also had a sore throat and a raspy voice which makes talking difficult. Thankfully I'm seeing the asthma nurse again on Tuesday so I hope I can go back onto seretide in conjunction with the ventolin again or anything other than this inhaler. 

  • I never expected such a response to my comments about DuoResp    I feel cross that we have all been affected in this way.    I'm a bit ashamed to say I didn't complete the form Teva sent me as they made it so hard for me.  You had to have all sorts of paperwork and receipts which I just didn't have anymore.     I've been changed again on to Fostair (I think I could write my autobiography as a history of inhalers starting with my early days as an Intal user of 5! ;-) ).   Fostair is also very gritty and it's difficult to get it to go into the lungs as it often just settles on my tongue and throat.  This often leads to me having a husky voice which is a pain for me as I'm a singer among other things.  Becotide and its family used to do this to me years ago.  Gah!  You can't win eh?

  • Im so glad I found this post. I started using the Duoresp a couple of weeks back since my doctors changed me from Symbicot. I'd previously used the standard Ventolin but despite my best efforts to rinse after using I got serious oral thrush. This has now happened again...

    I've been feeling ill ever since starting to use the Duoresp, symptoms started with a sore throat and dry cough and have been feeling worse and worse ever since. This resulted in a week in bed and three day off sick from work.

    Last night I found this post and everything fell into place.

    I spoke to my local surgery this morning and will be getting a call from my doctor later this morning.

    When I found out that this change in medication that was without consultation have effected my life so much for the last 2-3 week. I absolutely fuming!!!

  • I started using duoresp 6 weeks ago I didn't have any problem regarding the breathing at first then a couple of weeks into taking it I got swellings on either side of my head causing me to feel sick and dizzy. Whenback to doctors never thinking it could be the inhaler be a use I've never had and problems with previous inhalers. 6 weeks on I finally decided to stop taking the inhaler because symptoms were getting worse and told my doctor he said he dismissed the inhaler causing the swelling because he hadn't had anyone with these symptoms before even tho the first symptom on the booklet says 1 in 1000 people may get facial swelling. I've been off work for a week now with all thesymptoms and the way things are going think it will be another week on the sick. has anyone else had this problem and if so how long did it take for the symptoms to subside.

  • You can make an entry on the yellow card system here

    they log unwanted reactions. I've just been to the pharmacy to pick up my symbicort only to find they'd changed it to this generic stuff -which I refused to accept. I cannot afford to get ill again with asthma and quite frankly I'm not prepared to be a guinea pig. The UK pharmacy association has advised pharmacists not to make the change and the NHS in Wales has told doctors not to change patients over without seeing them first.

    I've written to my GP asking for symbicort and saying that I don't want to change the delivery system since I know how to use symbicort and have no idea how to use the new drug - and after reading the posts here I'm really worried about it!

  • hi am also nu 2 this site, I haven't had no probs wiv the spiromax, but if I only take 2 puffs of it at night time by the next morning I'll definitely start 2 wheeze, so my GP has said 2 me 2 take 3 puffs at night time instead, during the day my asthma is under control.

  • Hi im also on the duorasp was first put on the 120mcg and thought yeah this seems to be helping. Then after month or so my chest began to tighten and couldnt get any ease so they changed me to the 320mcg 1 puff a day. I also suffer with gallstones and dr told me they causing the tightness and being out of breath in chest. But after reading this post im beginning to wonder is it the duorasp not getting into my system properly. Im wheezing alot this week and have been told its chest infection. Due to see Dr again Tues im going to ask to go back to symbicort

  • Hi on my last asthma check up they told me they no longer make Symbicort and that I would have to move onto the DuoResp. I've been using the inhaler on and off as I still had an old Symbicort which I took to use at work. I've been struggling when using the DuoResp, today has been the worst and it just doesn't seem to be working, I'm not wheezing but struggling breathing, I've had headaches but only linked it to the inhaler since reading this thread. I also have bad shakes today which I never got on any other inhalers I've had.

  • Hello Alex, I am having exactly the same issues (I am 2 months behind you!), can I ask, did you get sorted on DuoResp or did you move back to Symbicort? I am not sure whether to persist with DuoResp. Many thanks for reading. RSKi

  • for the last week I've not been feeling great and had just started on the duo resp spiromax inhaler instead of symbicort. I've been waking up with very sore intercostal muscles - all the little ones around the side of my rib cage - which means they are having to come into play to breath while I sleep. I was beginning to realise that the inhaler was the problem - not having the effect that symbicort does - I was down to one puff a day with it and never had a problem - even when out cycling up hills or doing sport. Pleased to read that I'm not alone and I'm sure it is a cheaper version of the same drug so why doesn't it work? There's saving money and there's patient health,

  • I was prescribed this last week after being on the Qvar autohaler to try and bring my need for the Salamol down. In the past 24 hours i have had two "medium" sized asthma attacks within 5-10mins of taking this medicine and a few minor one's in the past week (which i considered would be while i'm getting used to the inhaler). Nothing else in my home or routine has changed, so there are no different triggers here, i can only asume that something in this inhaler is setting me off for some reason. It will take me around 2 weeks to get an appointment at our asthma clinic, so in the meantime, its back on my old qvar inhaler.

  • Hi I have had the same problem, since the coughing happened I've gone back to symbicort, I also used to take salamol inhaler they have stopped it, I don't know why

  • I actually got a chest infection and have been ill for several months because of the Spirmox inhaler. Constant coughing and wheezing. Feeling like I have the flu. My GP took me off of it and put me back on my old medication. I am still unwell several weeks after I stopped taking it. We are not alone. I know several people who have suffered the same thing. What is going on and why are they still putting people on the medication when it makes people very ill?

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