I've just had a review for my asthma and they are changing me to symbicort 2 puffs twice a day and I'm now to use it as my reliever too? I'm currently on Fostair 1 puff twice a day and ventolin but she said with current guidelines they are trying to reduce the amount of salbutamol use as its better to have more inhaled steroids for asthma control? I thought salbutamol was less damaging to the body long term than inhaling steroids? Trialling it for a month and told to then see how I'm getting on with it. My asthma is not controlled at the moment hence why they wanted a review.
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I don't think the argument used is quite correct Salbutamol is a short-acting bronchodilator so, although it gives relief for asthma, it doesn't control the autoimmune response which is causing it - that's why a corticosteroid inhaler is preferred. Also, if you are using salbutamol a lot, then it suggests that the condition is not being properly controlled in any event.
I use Symbicort Turbohaler (the dry powder version) for both COPD and late onset asthma, and I'm fine with it, but everyone is different and finding the right inhaler is a bit hit and miss. I'm not sure that changing from Fostair (which is the aerosol equivalent) is really going to make much difference, but Symbicort is much more expensive than Fostair so someone must have a good reason to suggest it. Probably best try it out and see if it reduces your Salbutamol use, which would be the desired outcome.
Symbicort and Fostair have different steroids and different long-acting bronchodilators in them so they're not a DPI/MDI swap but completely different meds.
Like you rightly said, finding the right meds is unique to us so it could be they are trying different ones for that reason.
Yes, sorry, I phrased it rather badly. I simply meant to say that Fostair was an aerosol and Symbicort dry powder designed to achieve the same ends but, of course, containing different components to achieve that - put it down to the effects of my second Pfizer jab!
Thank you for the reply. She said it is a dry powder so sounds like the one you have. She discussed increasing Fostair but thought this may be better for me to have the one inhaler for preventer and reliever. I've just been on two courses of prednisolone and still not back to being controlled so I suppose it's time to try something else. It's good to know that it's more expensive as that puts my mind at rest that it's beneficial for me and not just because it's cheaper. My review was with a clinical pharmacist and funded by astra zeneca, hence my scepticism.Everything you said makes complete sense so feel better about trying it now.
Salbutamol only relieves symptoms, it doesn't treat any underlying inflammation so shouldn't be relied on as a main treatment strategy (maintenance wise). So yes, asthmatics need to optimise the preventer medication to reduce the need for salbutamol. Of course that's the ideal - some people get told to just limit the blue inhaler which isn't helpful!
Finding the right preventer meds for each of us is the key though and can take a while.
Some inhalers like Symbicort can be used "normally" (ie twice a day regularly) with a salbutamol as reliever and they can also be used as MART - where you have regular morning and night doses and then a certain amount of extra puffs you can take as reliever. If they've put you on this (and it's definitely worth a try although it doesn't work for everyone as a regime), they should have been quite specific in what you take when and how you deal with symptoms. If they haven't, get in touch with the nurse or GP to clarify it for you.
As with all preventer meds, it'll take about 8 weeks for the symbicort to kick in properly so it's quite likely you'll feel more symptomatic in the meantime. The LABA element will kick in more quickly but the budesonide (steroid) takes several weeks. Again, check what you do to cover the gap - some people will be told to use the symbicort for relief (obviously in time the aim is to need the relief doses less and less but initially you'll probably need more of them), but others might be told to use salbutamol. But it depends what they want for you.
Keep tracking peak flow twice a day as, come several weeks time, the changes will help to show if the symbicort is helping you or not.
Hope that helps but shout if not!
Oh and the inhaled steroids are largely targeted to the lungs, not throughout the body, so they work where they're needed. Relying on salbutamol, as often used to be the way, is much more risky in terms of serious attacks and also in needing courses of oral steroids which have much more damaging side effects.
Emma's post on inhalers might explain more
Incidentally, Fostair can also be used in the same way as the Symbicort (as preventer and reliever) but it does sound like Fostair wasn't doing enough thing for you. Some people find Fostair brilliant, but for others it's not right. Hopefully symbicort will be the one for you!
Thank you. Yes I will be using it as the MART regime (presume that stands for a longer scientific term?). I have 2 puffs twice a day for the preventer side and 1 puff when needed up to 8 times a day for the reliever side. If really bad it can be up to 12 times a day but for no more than 2 days. Also no more than a week on 8 times a day otherwise I have to contact them (which I found obvious but I suppose some wouldn't).
Hopefully I will be lucky and it will be perfect for me and bring me back under control to where I rarely need to use it as a reliever. It seldom happens like this for me though but I can still hope 😂
You know what..... I'm delighted they've given you a comprehensive plan! Wahoo! So often people get told to use as reliever and that's their plan. Impressed with your plan! Sounds similar to mine when I tried MART ....from what I remember. Mine was eventually switched back to Symbicort as preventer but not reliever but for many the extra doses of symbicort are really useful.
MART . Yes..... just googling that 🤣.... Maintenance And Reliever Therapy! (Ok I thought it was going to be fancier 🤣)
Yes definitely much more efficient. She even explained how to inhale the dry powder and told me the name of a website so I could watch a video as apparently its a different technique. I think she is an outside source that the doctors have got in to do asthma review clinics (telephone appointments) this week and next.
I went the other way, from Symbicort to Fostair, both are combination inhalers but have different steroids but the same long acting bronchodilator. I swapped to FostairNext 200/6 as it has much finer particles and definitely helped.
It's horses for courses though and you'll only know by trial and error. And never hesitate to say if something isn't working for you, it's important to keep trying until you find what works best for you. Sometimes I think patients assume every asthma med should work for them but nothing could be further from the truth.
MART (using the combination inhaler for a reliever) doesn't work for everyone but you won't know until you try. If you respond well to steroids then it may just be the answer as by using it as a reliever on top of regular doses you'll be taking additional steroids (up to a daily max).
As for the Ventolin guidelines, their purpose is to ensure asthma patients seek timely treatment rather than rely heavily on Ventolin while their asthma continues to decline. It doesn't mean patients can't have Ventolin as a rescue inhaler per their asthma plan. When I tried MART for 6 months I always carried my Ventolin in the event of an emergency.
Hi, Symbicort controlled my asthma very well for quite a few years (not MART regime - not sure there was such a thing 17 years ago 😆🤷🏻♀️).
I was recently swapped onto Fostair MART as my asthma has changed over time and I was getting more exacerbations, but it didn’t really work for me so I’ve gone back to Duoresp Spiromax (same as Symbicort but cheaper I think). and trying other ‘add ons’ to see what works.
As everyone else has said, you have to find the meds that suit you as an individual. It can be a bit 😩and frustrating but hopefully this will work for you.
Thank you, I started on clenil and it didn't really do anything for me so was put on Fostair and that worked great for a good few years but now it's still not controlled even after 2 courses of prednisolone. My doctors sent a letter requesting a review and gave an appointment for the vaccine. So if they have taken the time to actively get involved, which they never have before, I will do as I'm told (for once lol).
I have used symbicort powder for many years and am very happy with it. But I feel that my asthma is getting worse year on year. Increasingly I have to rely on Montelukast to assist symbicort. I rarely have to use ventolin. I believe that regular reliance on ventolin is a sign that one's asthma is not under control.
My asthma and allergies seem to be getting worse the older I'm getting. I take montelukast daily also. I am relying too much on ventolin lately which is why she wants to try something different. She considered increasing the Fostair but preferred to change me to symbicort and remove ventolin completely. Ultimately it was my choice but I went with the option she thought was best for me. Fingers crossed it sorts everything.
Good luck. Have you tried anti-histamines ?
I already take Fexofenadine 180mg which still isn't enough but they won't increase it and wouldn't previously refer me but hopefully as they are starting to take more interest they may now refer me at some point. Last year I started getting hives when brushing up against some plants (I say plants, some were tree leaves etc and some were long grass, plants is just easier lol).
Wow Flower girl, you are even more atopic than I am. I am probably worse with horses, but also dogs, cats, budgies etc. But I can get also get hives from weeding. I am taking Fexofenadine for the first time this week.
I never used to be this bad. Didn't even have hayfever as a child but as I've got older I seem to be falling apart 🤣. Dont get me wrong Fexofenadine works, without it life would be unbearable, I only take it from end of Feb to beginning of Oct. Its just that unfortunately I've got progressively worse so it no longer works as well. I know that people take a higher dosage but you can only get that from a consultant not GP and as good as my doctors are for a lot of things, referring me is not one of them. I do downplay things so I'm my own worst enemy but I'm sure it will be sorted one day lol.
Will mention I have 3 dogs which I'm fine with except if I cut or brush their hair, then I itch like hell! My daughter (who doesn't have asthma but does have eczema) is highly allergic to horses and allergic to cats but not dogs? Allergies are very strange indeed lol
It's good that you can laugh. I guess the alternative is tears. Fortunately my wife has a strong constitution, so my kids don't have asthma and eczema in the way I do. Pick your partner carefully !!
I have developed random allergies in the past 18 months - when my asthma first started to be out of control, I have seen an allergy specialist I’m
Allergic to ally he usual things - cast house dust might, pollens etc etc I also have developed CIU - chronic idiopathic urticaria and he increase my fexofenadine to QDS, that has helped so much in keeping things a little bit more at bay!
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