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Huge Dilemma

Hi I was diagnosed with non small cell Lung cancer in November 2017. I was lucky enough to meet with the criteria to enable me to have Immunotherapy and newer form of treatment. I have been asthmatic for most of my life and for the past 30+ years it has been controlled and I have had little problem with it. However after I started on Immunotherapy it has started with a vengeance. They do not like giving steroid tablets and Immunotherapy together. The doctor changed my low dose Flixotide to Fostair last week and I thought this would help however I do not think that it has. I desperately need help with this. I don’t want the Immunotherapy taken away from me and am desperate to solve this. Please can anyone help?????

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Hi, I'm so sorry to hear about your cancer diagnosis. Glad to hear you have been able to have immunotherapy but I can see the dilemma! I am not a doctor or a researcher but my job involves reading research on and writing about cancer immunotherapy so I do know how the drugs work and it is obviously a problem given immunotherapy is unleashing your immune system to attack the cancer and many asthma drugs are trying to calm it down, as you probably know.

Do you see a respiratory consultant as well as an oncologist for your treatment? Could you ask them, maybe see if they can talk to each other? They may have encountered this before, more commonly in COPD patients who take some of the same medications as asthmatics, and might have lung cancer as well with the smoking link (I do know many lung cancer cases are not smoking related so not making assumptions about you, just thinking this may have cropped up before in that scenario).

As a non expert I would think you could ask about asthma medications which don't work by suppressing the immune system. They do exist eg I take tiotropium (Spiriva) which works in a different way. Obviously it is up to your doctors to decide and there will be other considerations I don't know about, but i would definitely think you could ask them about non-steroid options that .won't interfere with immunotherapy, even if normally your asthma wouldn't need it (Spiriva is more usually reserved for when steroids aren't enough, but not being able to have too much steroid also seems like.a valid reason).

I wonder if the British Lung Foundation may be able to help? They have a helpline and may be more familiar with drugs for both asthma and lung cancer. Or even if they don't, they might know who to ask or what to ask your oncologist and/or respiratory dr.

I hope this is vaguely useful but appreciate it is a difficult situation and one where you need to get the different drs talking to each other. Crossing everything that you can find.a solution and thinking of you!

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Thank you so much for your reply , I found it extremely helpful and reassuring, I do feel as though I am on thin ice at present, you gave me more hope and some other Avenues to try that I have not tried before. I shall try ring the Lung Foundation ASAP, will keep you posted. I am not under a respiratory doctor at present so maybe this is something that I could enquire about. Thank you so much.

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Very glad it helped and you feel like there is something to pursue - I hope you get somewhere with the BLF and others. I know some.respiratory drs do focus on lung cancer.

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Regarding your asthma flare up. Speak to your oncologist. See if they can speak to the respiratory team for advice. Between them, they may come up with an answer. I hope your immunotherapy goes well.

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