Advice please

[Tesco123]

I have been taking seretide inhaler for sometime now and the hospital nurse changed it to Symbicort 2 puffs twice daily with the option to take extra doses . I don’t if it’s the new inhaler but my asthma is now getting worse and I am having lots of attacks and coughing up loads more . I rang the hospital but my nurse is on leave until Thursday do I persevere or go back to my seretide . The nurse I spoke to said it was unlikely to be my new inhaler . I am really concerned as I was just getting better after a bad flare up

Thank you

[twinkly29]

When did you switch?The 2 inhalers contain different drugs and the new ones have to build up in your system which takes about 8 weeks. In the meantime it thinks it has no steroids so it feels worse.

So yes you need to preserve really if you've not been on it long.

[Tesco123 in reply to twinkly29]

Only started last week . But I really don’t want asthma to get worse and at the moment it is

[twinkly29 in reply to Tesco123]

In that case it will be that it needs more time. Unfortunately any new preventer medication needs a good few weeks to kick in properly and not giving it time makes it pointless even trying.

In the meantime I would

- use it extra times in the day as advised (as it kicks in you should need to do this less); this will add to the build up of the steroid so might help it kick in quicker and also give you a boost of long-acting bronchodilator each time you use it which should give some relief

- keep monitoring your peak flow twice a day (this will help to show improvement over the 8 weeks

- talk to your nurse or GP if you are concerned

[Tesco123 in reply to twinkly29]

Thank you so much you have been very helpful I will carry on and speak to the asthma nurse when she back of leave 😀

[Poobah]

Twinkly is right, in that it will take several weeks to build up the full efficacy of Symbicort. On the plus side, on paper, Symbicort performs better than Seretide and I assume that you needed a change in treatment because your asthma wasn't fully controlled. Having said that, only trying Symbicort for several weeks will prove whether it's the inhaler for you - not all asthma meds suit all asthma patients. If Symbicort doesn't work out then there are other options. Just ensure that you have a follow up appointment in several weeks in order to review how you are coping with Symbicort. I think it's a good idea to talk with the nurse when she returns to work this week. Good luck.

[Tesco123 in reply to Poobah]

Oh thank you so much . I had a better night which is helping me to feel a better about carrying on

[Superzob]

I'm certainly not a medical professional, but I've always been a bit wary of the argument that when you change inhaler you virtually start from scratch. The fact that Seretide has both a long-acting bronchodilator and corticosteroid suggest to me that the effect should continue for a while and the "new" (Symbicort) versions should simply take up where the others have left off.

What I do know, both from personal experience and others on this forum, is that some inhalers simply don't agree (or work) with some people, and it's impossible to predict this in advance. For instance, I react to the propellant in aerosol inhalers and others to the powder in Symbicort Turbohaler (if you have that one, though there is now an aerosol version).

I think you should try to speak to a doctor about this or, preferably, a respiratory consultant, because this is not something which should be left unchecked. Failing that, I'm sure the Asthma UK helpline can give you good advice (and put me firmly in my place if I've said anything wrong!).

[twinkly29 in reply to Superzob]

The issue is that the 2 steroids are different and take time to become effective. The original one lasts roughly 12 hours per dose as they're taken twice a day so are not going to last days or weeks once stopped. The new one takes the time to build up to full efficacy, though hopefully will start working during that time.

If it's say clenil to Fostair, I think (or I would hope!) it's largely "pick up where it left off" as it's the same steroid.

Absolutely agree that certain inhalers are right (or not) for each person - unfortunately unless there's a genuine glaring reason for stopping a trial sooner then perseverance is the key as some people find it does work well but that's only known after 6-8 weeks. Others might be lucky and find 2 weeks is all that's needed.

[Superzob in reply to twinkly29]

Thanks. I’ll need to look up the science behind this, as it does put people in a difficult position of not knowing whether they’re intolerant to the inhaler, whether it’s not working, or whether they need to give it more time. I guess you could take Ventolin for flare ups in the meantime, but that would seem to defeat the object of changing to a “better” preventer?

[twinkly29 in reply to Superzob]

That is the recommended advice usually - to use ventolin if needed during that period (which of course should reduce in need as the steroid kicks in and indeed once the new one is embedded should not be needed much). Combi inhalers do contain a LABA (long-acting bronchodilator) as well which should help - not sure how long these take to be fully effective but it's significantly quicker than the steroids.

One should always contact their nurse or doctor if concerned - sometimes people do need a short course of oral steroids to bridge the gap. Really new preventers should be started AFTER a flare (if one is currently happening) has been treated otherwise then someone has asthma that's already rocky having the known steroids effectively removed as well. I don't think such sensible approaches are always used by nurses or doctors though.

It's worth mentioning that an inhaler not being the right one for someone doesn't mean they are intolerant to it and by giving up for some mild (usually temporary) side effects and/or a temporary dip in control (or increase in symptoms), is effectively ruling out a treatment that might turn out to be perfect once it's had its proper time to kick in. Of course I don't mean major issues, that's different but also rare.

Subjectivity is another factor I think - as with pain, everyone will have levels of symptoms they are able or willing to tolerate. For example, some people feel any breathlessness or tightness is terrible and that more than 2 puffs of ventolin is severe - whereas others can be more rational and think that they can sensibly monitor things as they know the reason for the issues and it's a case of time. But it's personal.

Monitoring is an important tool during a trial. Measuring one's peak flow consistently (twice a day, usually before meds) can help to show that the inhaler is helping (over the course of the 8 weeks). Conversely, the evidence is useful at the end of it if it's decided that it's not the right medication.

The whole thing is a bit like antidepressants - they take weeks to kick in, usually with side effects in the meantime, and one has to give it the required time before that is known.

Sorry that was really long! 😬

[Tesco123 in reply to twinkly29]

Many thanks

[Superzob in reply to twinkly29]

But very informative!