Inhaled Steroids Question

[Matman]

I've gained the impression that there seems to be an upper daily limit on Inhaled Steroids around the 1000 Micrograms (mcg) level. However, when it comes to Oral Steroids - in pill form - both 'low' and 'average' daily dosages far exceed this, and are measured in Milligrams (mg's) with each Milligram being the equivalent of 1000mcg.

I'd like to know why there seems to be this restriction on Inhaled Steroids at 1000mcg when you can take a 'much higher' doses in pill form (i.e. 10, 20, 30 times that amount).

When I was FeNO Tested for a week (Fractional Inhaled Nitric Oxide) as part of the Test, my daily inhaled steroids were temporarily (for seven days) raised from 1000mcg to 2000mcg and, by the end of that week, my FeNO Score plummeted (by around 30%) to 48ppb (48 parts per billion) from 70ppb at the beginning of the week.

You may be aware that FeNO is one of the Tests used to gauge Lung Inflammation, the idea being that - the lower your FeNO Score - the less Inflammation is present. (Lower Lung Inflammation often translates to fewer respiratory symptoms).

So...if we can tolerate 'much higher' doses of Oral Steroids in Pill Form, why can't we Inhale higher doses of Steroids than the 1000mcg Ceiling that seems to be in place (or maybe we can, and I've just got this entirely wrong)?

Thanks in advance for any answer / reply you are able to provide.

[PMRPete]

Here is a very comprehensive explanation:-

pharmaceutical-journal.com/...

You will only be allowed one access to this article!

Another useful article from NZ:-

medsafe.govt.nz/profs/PUart...

[Matman in reply to PMRPete]

Thanks for that. Appreciated. Odd that stepping up the Inhaled Steroids beyond 800mcg are said to have little additional benefit (even though my one week increase to 2000mcg 'Inhaled' certainly seem to significantly benefit / reduce my FeNO Score). Also odd that the safety risk of more than 800mcg (inhaled) is implied to be higher than 10x the Dose taken in Pill Form. Still, 'things are as they is' I guess.

[S4r4L0u153 in reply to Matman]

It is weird, although I am on a daily dose of 1000mcg of Flutiform and I'm allowed to increase it to 1500mcg when my chest is playing up. This works out at approx every 8 wks I up the Flutiform for 2 wks, and then lower it again to 1000mcg.

[Matman in reply to S4r4L0u153]

Thanks. That's interesting. Although 'permanently' increasing my Inhaled Steroid Dosage beyond the 800mcg I currently take daily seems 'risky' - given your comments - it may be feasible for me to 'up the dosage' for short periods, as and when I get an Exacerbation. I'll check with my Consultant when I next see him in May.

[S4r4L0u153 in reply to Matman]

Good idea to ask. I was told last May I was allowed to temporarily up the Flutiform to 1500mcg a day. I have another review in May and will let her know the frequency of me doing that. It has kept me from needing oral steroids.

[Choristermum]

The article seems to fly in the face of the Symbicort SMART regime, where my standard daily dose is 800 (2x2 puffs) yet I can take up to 6 additional doses in a 24 hour period, potentially raising my dose to 2000 a day when needed. I have found being able to adjust the dosage very beneficial and have now gone 3 months without oral steroids - the longest for years.

[Matman in reply to Choristermum]

Appreciate the comment. Increasingly interesting that some people are benefitting from higher dose Inhaled Steroids

[Egret_J]

My daily regime is 1000mcg Flutiform (used to be Seretide but changed for cost reasons) and Ciclesonide 640 msg rising to 960mcg when needed. Hospital dr at one point put me on a third medication, spiriva, but I didn't tolerate the side effects. I have been told this is preferable to being on daily steroid tablets for maintenance, especially as I am also diabetic. So I wasn't aware of a cap on inhaled steroids.

[Matman]

Thanks. I'm beginning to wonder if there perhaps isn't a strick guideline as to how much daily inhaled steroid is permissible, but instead possibly more of a flexible one.