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Ventolin being stopped for asthma suffers

Wheesy
Wheesy

Happy New Year to everyone

Whilst in hospital last week I heard rumors that ventolin was being stopped for asthma use as it is causing deaths. I am 68 years old and when at school some of my friends were asthmatic and used ventolin and still alive thank god. Has anyone heard or read anything about this

Stay Safe Keep Well

46 Replies
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EmmaF91
EmmaF91Community Ambassador

Not true

What they may try and so is to switch people on to MART regimes (there is a movement towards this atm)

The research is focused on people who over-use ventolin and have it as part of their maintenance drug regime, rather than as emergency reliever. Some people in other countries such as the USA (this was a global study) don’t use things as steroid inhalers as their basic meds regime, but they do use salb nebs, and the over reliance on the reliever as their preventer results in them not seeking help or the nebs not working as well as they should when they need them.

From the sounds of it (and one of my concerns) is that people won’t understand the research and will stop ventolin for everyone, rather than focusing on ‘this dose use is too high’ (so maintenance meds need escalating) or ‘they still use vent as a daily med and that needs to stop’ (so maintenance meds need escalating 😉)

Hope this explains things better

What is Mart? I’ve been a asthmatic for over 30 yrs and have copd and never heard off it, I don’t have any plans either

EmmaF91
EmmaF91Community Ambassador in reply to Wanttobehapppy

MART is ‘maintenance and reliever therapy’. It can only be used on 4 inhalers in the UK I think (symbicort, fostair, duoresp and fobumix) and of those, it’s only licences for lower doses I think. But it’s where you have 1 inhaler for both maintenance and reliever 😉. The theory is the long-acting bronchodilator (LABA) in these inhalers can replace the short-acting bronchodilator (SABA) which is usually salbutamol, as well as giving a ‘top up’ of the steroid component to help control things longer term.

However there is a cap on the amount of doses you can take in MART, and they usually have different advice of what to do if they drop to the red zone in their asthma plans.

For some people MART works brilliantly, for others it doesn’t do much, so if your suggested to transition onto MART it’s usually recommended you keep the ventolin for just in case until you know that MART works for you.

MART is different than just escalating/deescalating maintenance (as some people will be told to double dose during times of issues for them, like winter, or during flare ups etc) whilst still using vent to treat an acute issue, as with MART your only inhaler is the preventer inhaler which you can use in acute situations.

Hope this helps explain things 😅

Thank you very much

Beetle53
Beetle53 in reply to EmmaF91

Thanks EmmaF91 for the MART explaination - I've been using ventolin for 50+ years, then at beginning of covid got told to increase my symbicort throughout day and take less ventolin... Didn't really know why... Makes more sense now.

Jimmy-Lyden
Jimmy-Lyden in reply to EmmaF91

Ahhh, this goes some way to explain why someone recently gave me laldy and started, in my opinion, ranting & raving about how I didn't know Ventolin was a killer and how Doctors were killing people with over usage and keeping the deaths quiet (this happened online). Quora is an odd place when you end up talking to some conspiracy theorist.

I have no heard anything of the sorts! I’m a nurse prescriber (but not for asthma) and would get all sorts of alerts but I haven’t got one for ventolin. Now that can’t be taken as gospel however I doubt it’s truth as there would have to be an alternative made available.

Wheesy
Wheesy in reply to Dogruff

Thanks for those helpful comments

I'm on Fostair Mart and also on Ventolin. In the Fostair instructions it does say you should always have your quick acting reliever with you at all times.

My ventolin is on my action plan, with Fostair Mart.

My CNS said I was use my ventolin as my blue light inhaler as it works faster.

So I hope this unlikely?

Wheesy
Wheesy in reply to Blue-Breeze

Hopefully you are correct as a lot of asthmatics use ventolin

LeiLey
LeiLey in reply to Blue-Breeze

Hi how do you find the Fostair Mart regime if you don’t mind me asking? I have been on Fostair 100/6 for over 3 weeks now and my asthma nurse said I can either take extra puffs of it as a reliever or continue with ventolin. I am wondering whether to try the mart, thanks LeiLey

Blue-Breeze
Blue-Breeze in reply to LeiLey

Hi LeiLey I take 2 puffs morning and night as my maintenance dose. I found it a job to settle in to at first, and it gives me cramp at full max dose. However I do like the fact that I can take extra if my PF is low I'm SOB coughing etc. I carry both ventolin and Fostair with me. Did your asthma nurse do a asthma action plan for you?

LeiLey
LeiLey in reply to Blue-Breeze

Thank you. That’s sensible to carry them both. No I haven’t got an asthma plan that I’ve seen, I’ve only been on inhalers since October so I wonder if that’s why. The asthma nurse is ringing end of Jan to check how I’m getting on.

Beach_48
Beach_48 in reply to LeiLey

Hi, i was diagnosed with asthma 2 years ago and very daunting at the time. My asthma nurse helped me with my asthma plan and i showed this to my family and where i keep everything i need in case ofcan attack. Luckily, touch wood, my asthma is mild and ive never had an asthma attack. Stay safe

LeiLey
LeiLey in reply to Beach_48

Hi that’s sounds good, having a plan and showing your family. Did your diagnosis come out of the blue as an adult, bet it was a bit overwhelming. Touch wood your asthma stays mild , thank you, stay safe also 😊

Blue-Breeze
Blue-Breeze in reply to LeiLey

My CNS at the hospital said to use ventolin as it works faster. I did mention this before. So I carry both. If I'm out and get very SOB ventolin will help quicker. Hope your asthma nurse appointment goes well.

LeiLey
LeiLey in reply to Blue-Breeze

Thank you, yes I can understand carrying the ventolin still. I am to take mine to work the asthma nurse said just in case I get symptoms. Thank you 😊

Beach_48
Beach_48 in reply to Blue-Breeze

Hi, this is also the regime for me and i find it works well. I take 2 puffs morning and night and can take 2 extra in the day if needed. I was diagnosed with mild asthma 2 years ago.

I was using Salbutamol & Fostair but was then changed to Symbicort. Previously I'd tried Symbicort with Bricanyl as my reliever but I'm now on Symbicort alone (perhaps it's a different dosage)... so far so good, although I don't get the instant relief of Ventolin it kicks in around the 2 - 3 minute mark.

Hi. I was on Symbicort 200/6 MART previous to this. However with my exacerbations I was unable to suck (sounds bit daft, but was so weak). It was changed when I was in hospital to MDI version so I could use it in my spacer. Unfortunately I got more side effects so was changed to Fostair.

I didn't realise you can get a different version, good to know. As for the trial & error carry on, that is a pain. I hope you get your asthma under proper control soon. Good luck!

Thank you. I hope my next step is a referral to severe asthma clinic. It was on my discharge work after my last hospital tests, but with pandemic who knows.

In May 2019 I had a routine respiratory hospital outpatient appointment and saw a new consultant, from New Zealand. She was adamant that I stop using Ventolin as "it was no longer considered a suitable treatment worldwide". Basically, she was putting me on the MART regime and after a heated exchange, she agreed that I would carry Ventolin for emergencies only. Of course, first thing I did when I got home was Google this assertion and couldn't find anything to suggest that Ventolin was being withdrawn as a standard asthma treatment. However, I tried MART for 6 months and my asthma declined so when I saw the head consultant in the November he took me off MART, explained i don't suit MART and signed me off.Luckily, my asthma nurse saw me shortly after that for a review and switched me to Fostair and was happy that I continue with Ventolin. But they do monitor how many Ventolin inhalers I request over the year. The emphasis is on seeking treatment if my Ventolin use goes up for a period of time.

I doubt that Ventolin will ever be withdrawn as it acts quicker than long acting bronchodilators and can make the difference in an emergency. I think there would be a revolution if NICE tried to withdraw it!

I've had uncontrolled asthma since a suspected Covid infection in late February 2020 (I was not tested as it wasn't considered widespread at the time), I was changed from 200/6 fostair 4x daily to MART 100/6 fostair after a bridging course of oral steroids. I was sceptical given the lower dose but it plus montelukast has made my symptoms better though they haven't gone away completely. I do find it a bit tying though since I use one puff 4-5 times a day and I have to use a spacer and rinse well as I'm prone to oral thrush. It does give me a bit of control over my treatment but I do worry how well I'll manage it when back at work. Also I had been on it a short while before I realised the maximum dose was 8 puffs and I was using 5 at times and didn't have a plan as to what to do if I had an acute attack or used all 8 doses. I called my asthma nurse and she seemed a bit unsure herself so I asked if I should then try ventolin and she said yes. Touch wood I've not got to that point. It also means more frequent prescriptions which is a bit annoying.

The problem is when ignorant doctors and patients use Ventolin as their ONLY method of resolving asthma - you should be looking at 1-3 daily preventers and only using Ventolin when that doesn't work. Its the same theory as when many were stopped from having home nebulisers as they tended to forget their preventers and then get into trouble - not advise their GP they were relying on their nebuliser then getting into severe acute stress resulting in emergency admissions....

That’s me, I have a Ventolin inhaler that I never use, I carry it because my asthma nurse said I ought to but I’ve never used it. I only ever use my brown preventer. I use my brown Clenil preventer either 1 or 2 puffs morning and night.

When I was really low last Christmas and discovered my peak flow was half of what it should have been I dug out my asthma plans and followed it.

I doubled up morning and night - think I possibly had a puff of Ventolin but it made me really shaky which didn’t feel nice so I didn’t use it again.

I agree with you Birthday 60. there is no way (or I don't think there is but I’m not a doctor) that Ventolin should be anyone’s only method of controlling their asthma.

Saying that I can’t imagine that they will stop it. A lot of people do need it as back up.

Please excuse my typing....im very clumsy.....this is absolute madmess to stop ventolin. Are the doctors going into the business of toture, or cruel and unusual punishment?? What arrogance.!! Are there any doctors who get adthma, ....probably none with severe and chronic asthma. My life would not be worth living if ventolin were taken away. It is a marvellous drug. My god there is a fashion aspect to drugs!!.....always doctors trying to get kudos with "research"...,...doctors who have no asthma themselves...but can go to work with a full lung function....I suggest before they take away ventolin ...get off to work with a large strap around ur chest so that you cant inhale what you need....altho asthma is largely exhalation issue...but yeh, a tight strap around ur chest whilke you work all day will give you some idea. This so-called wisdom of non-asthamtics makes sick....So much for ABC!...baaagh!! Try to understand your patuent...take notice of what THEY say helps them.

Anniecath
Anniecath in reply to bess7771

Agree with you entirely.

I agree entirely with your comment. It would be quite funny to see A & E doctors trying to breath with a tight chest and told that nothing was wrong your sats are fine. My sats are quite often fine they do not realize that although my oxygen is at 97% but my pulse is at 110 that something is wrong. Luckily I have an excellent consultant who says if I do not feel right to contact the respiratory team as to what to do with me as I have 4 different lung conditions. This also applies to the Paramedics who quite often say I do not require the hospital

bess7771
bess7771 in reply to Wheesy

yes it woulkd be very funny indeed to see these doctors wheezing and sweating away unabkle to breathe but going about their work.......oh take your preventers!! Do not take your ventolin.!! Dont worry about your present inbility to breathe...think sbout tomoro!!This ABC, this Airway Breathing and Circulation does NOT apply to you, you can exist on less breath than others...JUST SO LONG as you dont take that bad bad ventolin, which is so old, so out of fashion......I KNOW WHAT YOU FEEL....YOU DONT KNOW WHAT YOU FEEL.....

bess7771
bess7771 in reply to bess7771

yes i too have real problems with preventers and i wish i did not, but i do try to persevere because i can see the sense BUT IF THEY STOP VENTILOIN this is an absurd thing ....i can not imagine it. I feel really angry at the thoiught.

My God I hope not! I can't use any of the preventers, they all give me side effects. But since when did doctors listen to their patients? I HOPE this is just gossip.

Hi everyone. My UK asthma nurse placed me on a maintenance therapy of Fostair with one or two puffs morning and evening and Ventolin as needed in a flare up. I was also told to use my Fostair more often if I was suffering with an upper respiratory infection. I was never really told that the Fostair could be used instead of Ventolin and this theory is news to me. I recently posted on here that where I now live in Greece, my local Doctor has repeatedly tried to get me to come off steroid inhalers completely and just use Montelukast. I have resisted that as I am an anxious individual and I am quite frankly too put off that drug by it's possible bad side effects. Last time I saw him, he said that Fostair was an old out of date therapy and as I didn't want to stop inhalers, he prescribed me 2 inhalers to be taken 15 mins apart, 2 puffs X 3 times a day. They are Bocacort S and Seretide which is Fluticasone proponionate and Salmeterol. He said they were much more 'modern' drugs than Fostair and I should try them. Well I did try them, but not the Montelukast. They made me cough and cough, and after about a week they made me really depressed. I didn't realise that they contained Fluticasone as when I use that for hay fever in a nasal spray it also makes me depressed. So I stopped them and returned to Fostair. When I next see him I will request to continue on that...but I know I will have a battle on my hands about that, and the Montelukast, as Greek doctors do not like to be contradicted. Just another little bit of stress to add to the mix! Stay safe everyone!

Poobah
Poobah in reply to Lynxy7

Montelukast was brought to the market in 1998 and Fostair in 2014. Therefore, Fostair is a younger medication than Montelukast. Combination inhalers like Fostair are main treatments for asthma in the UK. Montelukast doesn't work for every patient as not all asthma is the same. A trial of a couple of months to see if it improves symptoms is the only way to test its effectiveness for you. It's not usually used as a stand alone treatment for asthma but can be used for allergic rhinitis.

If you Google "asthma Stepwise guide UK" you can see how UK introduces a range of asthma treatments to tackle mild to severe asthma.

Lynxy7
Lynxy7 in reply to Poobah

Hi, thank you for that valuable info! I had no idea Fostair was a more recent drug than Montelukast...sometimes I do wonder at some doctors' knowledge or even motives..i.e. pushing a certain product because it's made in the home country or is cheaper to produce. I will persevere!

Nutzs47
Nutzs47 in reply to Lynxy7

That’s strange as I was on seretide from when it was a new drug in the uk but about 5/6 years ago my local chest clinic wanted people on Fostair as it’s supposed to be better (also cheaper or so a dr friend told me)so I’m now take fostair 100/6 2puffs twice a day but have gone from just having the seretide 250 to having montelukast ,spiriva ,fexofenadine and nasobec nasal spray along with the fostair so not sure how much better it was

For me, i have tried using over 5 inhalers just to know the ones i can be using if one isn't available. I tried sulbumol, sulbuhaler, salbair, but could only use sulbumol inhaler conveniently before switching to ventolin, because the others became very scarce. After the switch, i discovered i couldn't use any other inhaler at all except ventolin (the ventolin shut my system to it & other inhalers). Also, after using the ventolin for so many years, i later doscovered that i don't get a relieve from the same ventolin so doctors have to make do with giving me Aminophylline 250mg & Hydrocortisone 200mg IVs or placing me on admission to take Aminophylline through drip or being nebulized hourly. From march till December 2020 i didn't use the ventolin. So i guess the stopping might be due to the fact that once you're too dependent on it, when you need it, it might not be effective.

I've heard this before and of GPS rationing ventolin use

The only alternative is bricanly or generic salbutamol

However as someone else has said there are an alarming number of people who "over" rely on ventolin and use it daily or even worse multiple times a day which is why they are starting to use words like rescue inhaler and blue emergency Inhaler .... so psychologically you think this is for "one off emergencies" or times of "requirement " (flu, cold etc) and not to be used daily

I believe the issues with using ventin daily are that *statistically * you are likely to have poor asthma control and end up in trouble at some point

Chip

My consultant treats each patient as an individual, saying that no two are the same - therefore the medications required by each person are different. She has me using an unlicensed program of Fostair 200/6 as MART, (2 x puffs am & pm and up to four times throughout the day). Each puff is immediately preceded by a puff of Ventolin, then in the morning, immediately followed by Spiriva, Carbocisteine, Omerprazole and Mometasome Fluorite nasal spray. After the evening Ventolin and Fostair, Carbocisteine and Mometasome Furoate - the Spiriva is swapped for Montelukast. It has been working pretty well, although things did go a tad haywire immediately after Christmas, when a call to 111 saw half of ‘Holby City’ at our door and me on a nebuliser - followed up with a 14 day course of Prednisone...🤦🏼‍♀️🤦🏼‍♀️🤦🏼‍♀️ Pleased to say, I’m back on an even keel now....

All of the comments are very interesting to read through, that everyone has different experience with the inhalers. I have eosinophilic Asthma and the last couple of years is really hard for me.

I get Mepo every 4 weeks, use Fostair 100, Sabutamol, Spiriva.

I have to say that I don't like Ventolin I know lot people say is the same like Sabutamol, I do get a headache when I use Ventolin.

I also didn't hear anything about that Ventolin gives problems. Thanks for all the comments here 😊👍

I take salbutamol but I always thought it was for emergencies not for everyday use as if you need to use it that often your asthma is out of control .My asthma plan is more of a maintenance one and if my peak flow drops or I have a cold etc I can take extra 3 puffs of fostair but only for 5 days then it’s rescue preds and a drs app for me,luckily this works for me as I’ve never been hospitalised yet and I’ve been asthmatic for 29 years 🤞🏻🤞🏻🤞🏻

Lysistrata
LysistrataCommunity Ambassador in reply to Nutzs47

Yes, needing reliever more than 3x a week is a sign of poor control. However, it's the needing it that's key here. If someone finds themselves needing it more (over the 3x a week level), or it's helping but not lasting, they should definitely be contacting their doctor for a review (or calling an ambulance if 10 puffs don't help or they're too breathless to speak, eat, or sleep).

However, I don't think it's helpful to frame it as 'emergency only' as people may then not use it when they need it. It isn't an epipen and avoiding using it except when you feel really short of breath or in an emergency isn't the best way to use it, nor will that remove the problem that if someone *needs* it that often they are poorly controlled. I feel even healthcare professionals can fall into this trap at times of thinking 'just don't use it that much' when the actual issue is how often are the symptoms occurring that prompt its use.

I also think a lot of people are given the impression that something bad will happen if you take it more than the recommended dose - again no, this isn't about the drug itself being bad, it's about the symptoms making you use it that much, and if that's happening you need to do something about it.

Sadly it seems like many people do not have a plan like yours (glad it's working), get confusing information when they're diagnosed and think they should save the reliever for dire emergencies when they can barely speak - or on the opposite end, think that it's ok to use it by itself as needed, without a preventer.

Nutzs47
Nutzs47 in reply to Lysistrata

Ta hun I also think it helps to have an upbeat take on asthma I have had to learn that no matter how many meds I’m on it’s up to me to keep aware of what my lungs are telling me.I work with my main trigger and have had to adjust and accept there is a line between doing ok or not and I do carry my reliever and do have to take it now and again I also have to carry water with me to help with the build up of paper dust xx

I couldn’t imagine life without my ventolin, I have lots off chest infections though out the year probably average 4 a year, I know when to take it and when it’s best for me, also I would feel extremely anxious if I’m without it due to flare ups, I’ve had asthma for all off my life due to having pneumonia when I was a baby was in a special needs school til I was 10 yr old, I’ve tried lots off different inhalers

If your GP surgery is as awful as mine this could happen. They put me on MART then refused ventolin while i was having a major flare, even when the A&E dr wrote in my discharge that i was finding dry inhalation difficult (luckily they gave me 3) after 2 short courses of pred they refused more and told me to just sit it out, obviously ended with me flaring futher and needing admission. Id give my right arm to be under a specialist right now

This is not good news. Luckily I have excellent backup from my specialists {Please note the plural} sometimes they will phone me at home to see how I am, and also my Asthma Nurses at the hospital, and my GP. My suggestion is to change your GP and complain to PALS about the care which you are receiving from this GP practice. I would also request that you get a consultation with an Asthma Specialist. Hope that this of help to you and keep your head up and smile.Keep well and Safe

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