Fostair- benefits and side effects - Asthma UK communi...

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Fostair- benefits and side effects

Calmcat
Calmcat

Hi All

I was put on Fostair a few months ago - fine for about 6 weeks then feeling worse again. A few days ago (during my current flare up - worst yet and first A&E trip - joy) I have been told to double it to 2 puffs four times a day. I have been doing this and although my peak flow is coming up a bit i am getting worsening shortness of breath on minor exertion. It’s like I can set off walking at a normal pace (I even forget that I will have a problem sometimes!) and breathe normally but after a few steps I’ve become exhausted - like a tight band round my chest makes it not impossible to breathe but exhausting. I’m left gasping for breath with head between legs. I can do a good stationary peak flow because - just like when walking- I can push through the tightness for a bit before it gets too much.

Is there anyone else had anything similar?

29 Replies
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I used to get something like this Calmcat, not the tightness but the breathlessness. I now take a couple of blues before I go out, or before I do something ‘strenuous’.

Calmcat
Calmcat
in reply to Troilus

Thanks Troilus- glad you found a solution.

I’ve actually been told ‘no ventolin’. The doubling of the Fostair is all that’s allowed....

Amy2091
Amy2091
in reply to Calmcat

This sounds like poor advice. It's common to double up the preventer if things aren't going well, but ventolin is just as important. I'm going through a "flare up" atm but my peak flow is actually fine, so my action plan didn't help me much as I don't really need the rescue meds, but I was advised to stick to doubling the fostair and relying on a little extra ventolin until things settle (I'm using waaaay too much - which can't be good) but at least it helps a little

Calmcat
Calmcat
in reply to Amy2091

Thanks Amy- very helpful. There seems to be inconsistent advice on whether ventolin should be used when on Fostair MART. i found my ventolin didn’t work when I took it along side Fostair. I’ve actually switched back to Clenil and ventolin four times a day (ie getting the same beclomethasone as I would on Fostair 4x day but effectively switching the the fomoterol component for salbutamol). I’m doing this because I suspect fomoterol may be causing me side effects (increasing shortness of breath on exertion. I got this effect with monteleukast too and only managed 3-4 days). Not sure with the Fostair. I’m feeling better (day 2 now but it could be coincidence). The real test will be if I switch back to Fostair in a few days and it gets worse. I plan to try this after another day or two if I feel brave enough.

I get rather confused about my breathlessness as I was diagnosed with late onset Asthma, then 3 years later a CT scan showed I have Bronchiectasis. But I can't tell which symptoms are caused by which condition! My peak flow is never higher than 300. I take Mucodyne twice every day, and use Salamol and Fostair 2 puffs twice daily. I also nebulise saline every day. My lungs are colonised with Pseudomonas (due to Bronch) but it appears to have calmed down over the last 5 years. Also take Azithromycin on Mon, Wed and Friday as a prophylactisc antibiotic.

I also take ;ong term 5mg Pred daily for another condition. Don't want the dose raised as I have Osteoporosis.

Hi Poems Galore

I don’t know much about Bronchiectasis - but it must be very confusing trying to work out which symptoms are caused by which condition. And quite a shock with the late onset diagnoses of both - I was diagnosed with asthma 5 years ago and lm still wrestling with it, denying it and hoping it will just pack up and go away! It clearly has other plans 🙁😕. So glad your pseudomonas have calmed down over the last 5 years.

Strange how different medics give different advice. When I was on Fostair 100/6 I was told to continue carry on using my blue, but that in the event of an emergency, I assumed that meant a full on attack, use the Fostair.

Calmcat
Calmcat
in reply to Troilus

Yes very confusing - my plan now says if I’m ambre (80% peak flow- like now) then I double. Then at 50% I call 999 - but still no ventolin. I don’t think she listened though coz I’d be really ill long before I went down to 50% of my peak flow personal best. When the GP sent me up A&E on Monday and I could still do around the 80% mark. It just left me gasping for breath afterwards! I’ve broken ranks and used my ventolin now - feeling better😀. Not sure what I’ll do when it runs out ... hopefully GP will support my choices over the consultant’s advice. Quite worried about the Fostair too so think I might go back to my old Clenil for a few days to see if it makes a dif.

Thanks so much for replying. Are you still on Fostair?

Amy2091
Amy2091
in reply to Calmcat

Fostair alone can be used as a ventolin, maybe this is why she has said no to using it? They do a MART thing (I'm sorry I don't understand much about how it works) where u use it as both a preventer and reliver. I haven't been shown HOW to do this myself so I use ventolin as I would have with any other preventer. It could be saving you so much hassle!

Yes. I started off on 100/6 but just for one month. I was started on it after my second visit to A&E ( but that’s another story.) My GP said it would take 6 weeks to kick in. Two weeks later I had a consultant appointment and he upped it to 200/6. 3 months later I attended clinic and they reduced me down to 100/6. ( I objected but was told I W was going on it ‘ just like everyone else.’ Six weeks later, two asthma attacks. Put on prednisone for 5 days by triage nurse. 6 weeks later another attack. Back on prednisone for 5 days and back on 200/6 by GP.

I have been back to respiratory clinic since, but I forgot to mention I was back on 200/6 😊

Calmcat
Calmcat
in reply to Troilus

What a journey you had!

Clearly it must be very inconvenient for respiratory clinics when we object and think we’re different and not ‘just like everyone else’! (I might also forget to mention my experiments with Clenil an ventolin next time 🙃😉🤣)

Troilus
Troilus
in reply to Calmcat

I think sometimes, Calmcat, they just don’t listen. Each time I have been to respiratory clinic and I get a copy of the report the things in it are inaccurate. The last time I had to ring up to point out that the ratio on the spirometry report was wrong. That was the only error they have bothered to correct.

I also had allergy blood tests taken. The report listed things I was NOT allergic to! How useful is that!

Honestly, my journey has been a catalogue of errors!

Calmcat
Calmcat
in reply to Troilus

Scary! So they only listed the things you’re not allergic to and they didn’t bother to correct anything except the spirometry ratio? I asked about allergy testing when I was there but they didn’t take it up. Or rather they did then seemed to forget about it. Did you find it useful at all?

Troilus
Troilus
in reply to Calmcat

Sort of. I had skin tests years ago and I remember my GP saying I had reacted to lots of things so would not benefit from immune therapy because it would be a constant roundabout, so I have taken antihistamine for years. I don’t remember the list. I remember I wasn’t allergic to cats because I had one at the time.

Blood tests confirmed I have allergies ie high ige, but like I said the letter contained a list of things I wasn’t allergic to. I have a sort of feeling that it is probably an error, and those are the things I am allergic to. For example, grass, tree pollens.

If you have never been tested I think it would be worthwhile. It least you know what you need to be careful around.

Calmcat
Calmcat
in reply to Troilus

Thanks. I’ll ask again about the testing. Might try again with an antihistamine as well perhaps. In the past I just bought something from the chemist but it didn’t seem to do much. Have you found any antihistamines better than others?

Kamilla22
Kamilla22
in reply to Calmcat

I am on piriton liquid version with fostair 100/6 and I am also on montelukast for me the 3 daily drug's work a treat.

The GP put me on loratadine which is what I have stuck with. I used to take it March to October, but this year I’ve stayed on it all year.

I also used to take Beconase nasal spray starting about June, but my GP said to keep using it this year because my nose was blocked. ( It cleared as soon as I started Montelukast) and then come July/ August I added in eyedrops.

On that regimen I didn’t have any problems. I was able to garden etc. A bit of sneezing in August but that was all.

I didn’t have asthma until August 2018 and at the time I just thought it was severe hayfever because of the hot weather!

Hi, I used fostair currently but don't vouch for it - at least not my personal circumstances anyway, it's excellent for some.

I was given spriva a few months ago as an add on medication and it has been AMAZING! I was told it would help the kind of symptoms you have mentioned above - not they usual wheezing/flare ups but the tightness and 'struggling to get enough air in' kind? I usually get this like you when walking or on exhaustion, I noticed a difference pretty much after the first use and if I miss a dose - i know! Ask about it and see if it's an option for you, it's been such a help for me x

Calmcat
Calmcat
in reply to Amy2091

Thanks. I think I will ask about Spiriva again. I was told on Tuesday at the clinic that they were going to switch me but by discharge they had changed their minds and just doubled my Fostair - no explanation- didn’t feel much of a partnership 😕

Amy2091
Amy2091
in reply to Calmcat

Ye I feel a lot of us are being pressured into Fostair - it's amazing for a lot of people but I certainly don't feel one of them (3 failed attempts with it but they don't listen!).

Spriva is an extra medication so shouldn't matter what preventer you will be using. My specialist said it's usually only given to COPD patients but they are seeing success with asthma too (I don't have COPD), I certainly saw a difference and would hate for them to remove this now.

Calmcat
Calmcat
in reply to Amy2091

Good to know Spiriva is working so well for you. And good to know I’m not alone with the Fostair issue

Calmcat
Calmcat
in reply to Amy2091

Can I ask- do you think Fostair was part of the problem - causing the unusual symptoms of tightness and struggling to get enough air in (as opposed the usual wheezing/flare ups) or just that it failed to fix your tightness problem?

(I haven’t really had much problem with the tightness thing before starting Fostair in the autumn so I can’t tell for me)

Amy2091
Amy2091
in reply to Calmcat

I was getting that anyway - usually only on exertion, I was changed from seretide to symbicort which I got on with great! I was then referred to specialists because my eosinophilic count is still way too high (even though I felt like symbicort was making a difference symptom wise).

I don't like fostair for a number of reasons but have been pressured into it 3 times now!!! Grr, and I feel worse now than I have in years, peak flow however is better but not symptoms - using more ventolin etc. I'm only sticking with it currently to see if I can bring eosinophilic count down.

Calmcat
Calmcat
in reply to Amy2091

Thanks- I hadn’t thought about eosinophils before. I presume they tested for that when they took my blood on Monday (?) but they haven’t told me. I guess I should ask them. Do you know if they test for eosinophils routinely or is it part of allergy testing (which I haven’t had...yet)??

Calmcat
Calmcat
in reply to Amy2091

So sorry to hear that you feel worse now than in years - even though your peak flow is better. It just goes to show peak flow isn’t everything! I hope the Fostair manages to bring down your eosinophilia count.

It sounds like you need to get your plan clarified. Fostair can be used as a MART regime (maintenance and reliever) but this doesn’t work for everyone, and only works with the fostair 100 (something docs can occasionally forget). If you’re finding that MART doesn’t work for you, you need to contact your consultant and tell her. Also have you been told the max amount of doses you’re allow each day? With fostair 100 it’s 8, fostair 200 is 4 (any more and you don’t get any addition benefit). So if you’re already doing the max dosage of your preventer for prevention, then it’s not going to work as a reliever (I hope this makes sense) and maybe explains why you’re having to use ventolin to correct issues.

Hope this helps

Calmcat
Calmcat
in reply to EmmaF91

Thanks Emma. I get what you’re saying- I’m using the 100/6 four times so yes there’s ‘no where to go’ if I need anything on top

Hi Calmcat. Re the discussion on Fostair as a reliever. This is quite a recent development and based on one study. But I would say that the efficacy of Fostair (or any combination inhaler) for the patient should be established first before asking the patient to use it as a reliever.

If asthma isn't controlled on Fostair etc why would a doctor believe that the medication would work as a reliever?

I think your explanation between Fostair and Clenil/Ventolin is interesting and I hope you can demonstrate a clear advantage, one over the other if only to get control of your asthma.

Thanks- I’ll let you know how it all pans out if you like

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