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Asthma harder to control after switching inhalers

Celie1
Celie1

Hi,

After reading a recent post it started me wondering if the reason my asthma flared up again, a couple of months after switching inhalers and has been difficult to control since, is because the switch wasn’t equivalent to what I was taking before. 🤔

For years I had been on a high dose: 2 puffs twice a day of Duoresp Spiromax 320/9 and this wasn’t stopping exacerbations occurring a couple of times a year, but then the latest being only 3 months. I was swapped onto Fostair 100/6 on a MART. (Plus the usual steroids etc) After a couple of months and when I was on 2 puffs twice a day of the Fostair, the breathlessness came back almost before I had a chance to increase the Fostair, then I was straight back on pred etc. Could this be because I wasn’t getting as much medication as I was getting before, when I was on the high dose Duoresp. needed through my inhaler. I read that the Fostair 100/6 is a medium dose, albeit with finer particles 🤔difficult for me to compare apart from my original inhaler dose was classed as ‘high’ dose and the Fostair as a medium dose. What do you guys think?

22 Replies

Maybe give one of the nurses (at either place!) a call? It could be the steroid in Fostair isn't the right one for you?

Was the 100/6 Fostair increased in number of puffs or increased to the 200/6 version?

Celie1
Celie1 in reply to twinkly29

Hi, thanks for your reply. The Fostair wasn’t changed to 200/6 version or increased in puffs, although because I was on MART I could have increased it, but the attack of SoB came on quickly and I was given steroids. Also gave me Atrovent for a week, then changed to Spiriva for a week, then givenTrimbow which I know has both in which I’ve.taken for a week now. I’ve had a wheezy, thick mucous cough ever since and having to take Ventilin about 3 or 4 times a day until it starts to work... unless that’s causing it! 🤷🏻‍♀️

twinkly29
twinkly29 in reply to Celie1

Ah yes sorry I'd forgotten about the new inhaler. I guess see how that goes over the next few weeks then - but monitor in case you pred in that time to bridge the gap with it being a new inhaler. It's most likely the changeover that's causing the symptoms/need for ventolin. Maybe with added tree pollen?

Celie1
Celie1 in reply to twinkly29

Yes you’re probably right. Sorry to be a pain! 🤦🏻‍♀️😆 just no patience- want it to be sorted quickly. Thanks 😊

twinkly29
twinkly29 in reply to Celie1

You're not a pain at all!

Celie1
Celie1 in reply to twinkly29

👍😁

Potency between inhalers isn't straightforward, unfortunately. Inhalers with fine particles are more potent than those with normal sized particles. Fostair is a fine particle inhaler so even though the numbers are lower, it is quite potent as it reaches furtherinto the small airways.

From what you say, you've been swapped between inhalers quite quickly, being on Spiriva and Atrovent for just a week each. But now you're on Trimbow, which is another fine particle inhaler. It has different a steroid to Duoresp Spiromax, but the same as Fostair. The LAMA is different to Spiriva and Atrovent though. So it's Fostair with an additional LAMA. Normally it takes up to 8 weeks to see the full benefits when swapping between inhalers with different steroids, but if you've gone from Fostair to Trimbow then you've stayed on the same inhaled steroid and I wouldn't expect a dip in control of your symptoms.

I assume the Spiriva helped and that's why you're now on Trimbow? The only downside to these triple inhalers is the fact you can't increase your daily dose in order to increase the steroid element, when necessary, as it would lead to an overdose of the LAMA.

If your symptoms are worse then definitely time to discuss an add on medication to get you through this exacerbation or to have a sputum test in case you have a chest infection. Maybe the LAMA isn't right for you. Never hesitate in telling your doctor that things haven't improved or they're worse - not every asthma med suits everyone.

Celie1
Celie1 in reply to Poobah

Thanks for the reply 😊.

The nurse who gave me the Atrovent did this as a ‘try out’ before putting me on the Spiriva (because it’s expensive). At the time I was on a 5 day course (40mg)of prednisolone, then tapering over the next fortnight. Also given antibiotics. I had a chest x ray which was clear.

I spoke to an AUK nurse (I think you suggested this- lovely nurse 👍)as I had developed a mucous cough. She said that she couldn’t understand why I hadn’t been put straight onto the Spiriva as this would have been better. She also said I should have a referral to a secondary or even tertiary care.

A few days later I spoke to the nurse at the local GP (as I’m away from my home GP I’m at a temporary practice) I said I would be willing to go straight onto the Spiriva (so that was the reason for this change). I also spoke to the asthma nurse specialist at my own GP’s, the following week just to let him know about the changes in meds and to ask for a referral. He decided to put me on the Trimbow as he said it was having the meds all in one go instead of with different inhalers. He also started the wheels in motion for blood tests, CT scan etc as he said it would be next year before I saw a specialist because of Covid.

What you were saying about not expecting a dip in control with changing from Fostair to Trimbow, I’m not sure the Fostair ever controlled it to the same level as when on was on the Duoresp Spiromax. Although the SoB symptoms improved, I had a cough, but a bit tighter than the one I have now, if that makes sense (those are my two main asthma symptoms). This is why I wondered if I was on a strong enough dose of the Fostair. 🤔

As if this post isn’t long enough already - sorry 😬, my asthma SoB symptoms were really bad this morning (my main problem at the moment is the level of mucous, it has felt quite thick and difficult to shift). I took 10 puffs through the spacer. I was a bit worried about what to do, I really didn’t want to have to go to hospital and be with Covid patients 😳. I started to feel better as the ventolin helped me to cough. I took the usual Trimbow, which also helped me to cough.

I saw a doctor a week ago and I told her I was having to take Ventolin every 4 hours , but she didn’t give me anything else apart from a ‘rescue’ prescription of pred. So after the scare this morning, I have started taking them again. But it’s only a week since I finished tapering off the last lot and I’m not sure I’ve done the right thing now! 😩I hate the thought of having to take these steroids, as the docs keep reminding me, they’re very bad for you. But I talked to myself 😆 thinking it’s Easter weekend and it might stop the flare up getting worse, so I hope I did the right thing.

Poobah
Poobah in reply to Celie1

Normally by now you would be referred to a specialist and covid may cause delays but it shouldn't stop the GP from referring you, especially as their efforts to affect positive change through med changes has left you in a worse position.

As you say, Fostair wasn't working as well as your Duoresp Spiromax so swapping to Trimbow does appear to be an odd progression. Maybe a complete change of steroid and long acting bronchodilator would have been better, say Seretide? I only say that as we know that what suits one person doesn't necessarily suit another. And now you have a phlegmy cough, which to me would be another step backwards, so you'rein a worse positionthan you were on Duoresp Spiromax.

I agree with the Asthma UK nurse that adding Spiriva to your Duoresp Spiromax would have made more sense. I would go back to your doctor and ask to retrace your medication steps as, from what you say, the Fostair combination didn't suit you as well as Duoresp Spiromax and you're still on the Fostair combo, albeit in Trimbow (as the steroid & long acting bronchodilator are the same as Fostair).

It's all very well taking oral steroids but not if it's covering up poor maintenance provided by your inhalers. My asthma nurse is also asthmatic and she said she had several courses of steroids & antibiotics before she realised that her maintenance inhalers were all wrong fir her - so even medical professionals have to figure out what's good for their asthma control too.

Celie1
Celie1 in reply to Poobah

Hi, thanks for that. I probably didn’t say to the doctor at the time that I didn’t think it was working, so probably my fault. I thought I’d have to wait the 8 weeks it normally takes to work effectively 🤷🏻‍♀️But I think what you’re saying is that the Fostair (which I’ve been taking since December) should be controlling the symptoms even if the LAMA isn’t yet fully working , is that right? I think I was so hoping the Fostair with its finer particles would stop the flare ups that I didn’t really think about the possibility of it not working and just went along with the changes thinking they would work 🤦🏻‍♀️Did I make a mistake in re-starting the prednisolone 😬

Poobah
Poobah in reply to Celie1

Not your fault at all. And neither do I think you made an error with taking more Pred. You are poorly and need extra treatment. I was just thinking that your doctor needs to have a recap on how all these new inhalers haven't helped and that Trimbow isn't going to work because Fostair didn't work as well as Duoresp Spiromax.

Inhaled steroids take about 8 weeks to get fully effectively so every time you start a new inhaler with steroids you can expect a dip, however, sometimes the steroid is the same from one Inhaler to another so there shouldn't be a decline in symptom control. From going from Fostair to Trimbow you are still taking the same steroid and long acting bronchodilator; beclometasone dipropionate and formoterol.

Long acting bronchodilator meds (LAMA) kick in from day one. They're like Ventolin but work for longer throughout the day. They are usually taken at 12 hour intervals but at least one is a once a day med. Ventolin lasts about 4 hours, less if asthma is bad. So if you have no improvement on Trimbow and feel worse then the LAMA isn't right for you.

It's difficult when you're at the doctors to know what exactly they are prescribing. Happens to me too. I get home then look up what's been prescribed. On one occasion I had a clear discussion with my consultant about the terrible effects that a particular LAMA inhaler had on me. At the end of the consultation he said he was going to prescribe a triple inhaler. It wasn't until I got home from the pharmacy that I realised that the new inhaler contained the LAMA I had highlighted as a problem for me! I rang the hospital and explained to the nurse I wouldn't be taking the new med and why.

For many asthmatics it takes trial and error to find the right combination of meds. It's just that you're in the middle of your search for the right cocktail right now. Use your doctor as much as you need to, but be clear about what your experience since you were taken off Duoresp Spiromax. Obviously things weren't fully controlled then but you weren't as bad as you are now. If you think it would help to talk to Asthma UK again definitely do that.

Celie1
Celie1 in reply to Poobah

Thank you so much.

That’s helped to clarify things for me, especially the bit about the LAMA, I didn’t realise that took effect immediately. You would have thought the fact that I told the doc last week that I was having to take Ventolin every 4 hours that she would have thought mmm... this new inhaler isn’t working. The trouble is because you see or speak to different people, plus the doc’s only got 10 mins I suppose it’s hard for them to get a handle on it. Even with your experience where the consultant put you on an inhaler containing the very thing you didn’t get on with 🤦🏻‍♀️🤦🏻‍♀️🤦🏻‍♀️!! and you know what your talking about so no foggy explanations there!

Anyway the more I have these chats and learn more from people like yourself on this forum, the more I will be able to have a viewpoint at the surgery.

It’s a bit tricky as well for me, being between two GP practices. I’m due a call on Tuesday from the asthma nurse at my own GP’s, so will be armed for a discussion about maybe changing again 🤞. Ready for another cocktail 😆hopefully the right one this time.

Very grateful for your advice and support 🤗 and hope you’re ok at the moment.

Poobah
Poobah in reply to Celie1

Good luck! Yes, I'm good at the moment 🤞, thank you.

Celie1
Celie1 in reply to Poobah

Thanks . That’s good news. 🤗

twinkly29
twinkly29 in reply to Celie1

If you do need hospital they won't just put you with covid patients - they may not have any anyway now, or very few. If people are admitted they're swabbed on admission. And they're not just assuming that breathing symptoms are covid. So please don't avoid hospital on that basis!

Celie1
Celie1 in reply to twinkly29

Oh that’s good to know. I’m managing now on Ventolin. I’ll see how I go. Thanks 😊

Hi . I was on seretide 250 4 puffs a day for many years. My prescription was changed to Fostair and within a couple of days of taking it I was coughing a lot my chest was wheezy and I suffered from cramps in my legs. I had a medication review a couple of months later and the GP said this inhaler doesn't suit you and I was transferred back to Seretide 250. My asthma is now well managed and I am much happier.Good luck

Celie1
Celie1 in reply to Welshtoffee

Thanks for your reply. It may be that I don’t get on as well as I’d hoped with the Fostair. I’m glad your asthma is well managed now.Thank you.

fenny123
fenny123 in reply to Welshtoffee

Which begs the question as to why a doctor sees fit to change a patient with no discussion onto something when what they are currently taking is working fine? This happened to me back end of last year and I've had 4 months of uncontrolled asthma, now a heart issue because of it. All because a doctor decided a change without consulting me.

BTW, did you know that doctors get paid to prescribe new medications to the market? Is *this* area of the UK *also* corrupt? Is *everyone* more interested in profit than people?

Aw sorry to hear about your experience, that sound pretty bad, with the heart problem as well!

To be fair, the doctor only changed mine, because I had 2 flair ups only a few months apart each treated with two weeks of pred and tapering off, so the previous inhaler wasn’t keeping the best control over my asthma 😬and he did consult with me first, which is good. I thought the Fostair would help too because of the fine particles as I think my problem is in the small airways. It’s just gone a bit more pear shaped since then, so as Poohbar said we need to backtrack and a bit of ‘trial and error’ is needed in my case to find the right combination.

Good luck

I’d ask for themTo make the referral to secondary care . The had 3 doses of steroid before Christmas as my asthma went off and they decided in the end I must have had long covid . I was referred by the gp for an urgent appointment to the respiratory clinic and had an appointment at the beginning of January where they added the spiriva and I had a follow up last week so being told it’ll take ages is not an excuse to not refer !

Hope they get you sorted soon

Celie1
Celie1 in reply to Rlbee1974

Thanks for your reply. That was quick for you, hope you’re on the mend now! 😊

I have been referred, although the specialist asthma nurse at my surgery said it would be a long wait, probably next year. I suppose urgent cases such as yours will be seen, particularly if Covid related. At least he’s (the nurse) sorting out the scan, bloods etc.

Just feel like I need something else now though. I started back on prednisolone on Fri but it always takes a while for me to respond to it, 🤦🏻‍♀️(I think I’m one of those people who it doesn’t work really well for as I always need longer on it) so I’m still waking early morning to take Ventolin and still coughing.

Hopefully he’ll be able to change something/give me something extra, when I speak to him next week.

Good luck 🤗

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