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C&PCCG Asthma Pathway - MDI or DPI?

For many years my asthma was well controlled by a combination of Serevent Accuhaler 50mcg 1xbd and Flixotide Accuhaler, 100mcg 1xbd (low season) and 250mcg 1xbd (high season). I also had, but almost never required, a Ventolin Accuhaler 200mcg. Two devices meant that I could tune the inhaled corticosteriod (ICS) while maintaining the long acting beta-2 agonist (LABA).

I really liked the Accuhalers. The rounded design was comfortable in pockets, they were fully enclosed when not in use and had a counter so you knew exactly how many doses were left and were sure of a full dose each time.

Last year I was switched to Fostair 100/6mcg (MDI), 1xbd (low season) and 2xbd (high season), with an Aerochamber Plus. So far, it seems to offer a similar level of control. Apparently, it has a shorter shelf life and the pharmacist has to store them in a refrigerator!

My treatment is now the 1st choice for step 3 on Asthma Pathway June 2015 from Cambridgeshire and Peterborough Clinical Commissioning Group. Looking through this document the majority of medications are MDI with few DPI.

I'm a little out of touch but is there now a good reason to prefer MDIs over DPIs?

I know that there is a DPI version of Fostair 100/6mcg, the Fostair NEXThaler. By chance, I discovered that one of my friends worked on the team that developed this NEXThaler. However, according to this New Medicine Report it has been designated NOT RECOMMENDED.

I am curious as to the processes involved. Does my CCG restrict the choice of inhaler type?

I would much prefer a DPI. Are there any good reasons why an MDI + spacer is considered better than the current generation of DPIs such as Fostair NEXThaler or Relvar Ellipta (also NOT RECOMMENDED)?

2 Replies


I have had a similar experience with dpi being switched to mdi. My nurse at the hospital tells me many consultants are anti dpi inhalers

I have used various dry inhalers throughout my life such as turbo and accuhalers without an issue. My breathing became increasingly bad during winter and I did not have. Enough breath to get the full dose of medication deep enough in my lungs nor was I able to hold my breath long enough.

I am now on mdi and spacer.


Fostair 100 was been suggested for me as well instead of a flixotide 250 accuhaler. I flatly refused to switch - which possibly annoyed the consultant who suggested it, although he admitted that the reason a change of medication had been recommended (the presence of thrush in my oesophagus resulting in oesophagitis) was unlikely to have been caused by the dpi I was using given that I've never had oral/pharyngeal thrush. My asthma has always been very well controlled by the flixotide (and ventolin when required - rare) so I'm wary about being put on something new when I am already on a medication that suits me so well.


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