Advice on increasing my Relvar dosage - Asthma UK communi...

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Advice on increasing my Relvar dosage

Mozza26 profile image

Hi,

I am prescribed Relvar 92/22 mcg once in a morning. My question is am I able to take an extra dose at night time when my chest is tight? I know a work colleague has been prescribed it four times a day when needed. Unfortunately I would ask the Doctor but trying to get an appointment is basically impossible.

Thanks 🙏

21 Replies

I use Relvar 184/22 once in the morning (Along with other inhalers and medication ) At one stage my asthma nurse told ne to take two puffs rather than the normal one. However when I spoke the the consultant she said go back to one as 2 would make no difference. Thats just my experience.Some others might have had different advice.

Mozza26 profile image
Mozza26 in reply to teddyd

Thanks teddyd I will definitely look into this before doing anything as it definitely is not worth taking more if it makes no difference. All the best for 2022!

I take it you haven't got an asthma plan which would detail how and when to increase your meds. I've been able to secure a telephone appointment with my GP after explaining to the receptionist that my asthma was in decline (this time last year) and had very good service in terms of obtaining additional meds to address asthma symptoms. Definitely call your GP for a telephone appointment explaining your asthma needs additional treatment - even if the appointment is with the asthma nurse, at least you'll be able to increase your inhaler under medical supervision.

Mozza26 profile image
Mozza26 in reply to Poobah

No I don’t have an asthma plan even though been asthmatic for 50 years! I’m waiting to see respiratory consultant. I have always taken Ventolin alongside my preventative inhaler but the asthma nurse said I shouldn’t need to do this. I was on Clenil and things had ticked over nicely. When covid started my anxiety went through the roof and found I suddenly felt like something was sitting on my chest. Obviously couldn’t get to see Dr so have been given various inhalers all done through telephone consultation and none seem to help. My problem is I now avoid taking the Ventolin unless desperate as Ive been told I shouldn’t need to and if I do then I need to get to hospital!! That’s the last place I want to go. I’m too scared to take it incase I’m not allowed to when taking the one puff of Relvar as that’s how it has been sold to me. I still think they are missing something and have messed all my meds up instead of looking more down the anxiety route and not breathing correctly but I’m just left confused. Thanks for your help 😊

Poobah profile image
Poobah in reply to Mozza26

Anxiety is horrible and it certainly is something that triggers my asthma too as it sets off poor breathing habits and asthma meds don't help with that. My asthma nurse wasn't happy with my daily Ventolin use and explained that I shouldn't be using it more than a couple of times a week. She put me on Fostair and I think it's one of the better inhalers I've tried, but we're all different and it's only by trying different inhalers can we find the one that suits us best. It's a long process as it takes at least 8 weeks to build up the effects of each new inhaler, together with repeated follow up appointments in order to review progress with each inhaler.

I do breathing exercises (Buteyko) in order to address anxiety and my poor breathing habits. Having been referred to a respiratory physiotherapist it was something that I wish I had known about as a child, if only to correct poor habits of mouth breathing.

I've been prescribed Amitryptiline a couple of times in the past for anxiety, as has my asthmatic friend. It was OK but I think that the breathing exercises suit me better. This video explains why breathing exercises can address anxiety, youtu.be/ur-IrETRulU

If your inhaler dose isn't sufficient I would definitely talk to the GP or asthma nurse and in the meantime use your Ventolin - it's a rescue inhaler after all. I would also recommend talking to one of the Asthma UK nurses (office open from Monday) asthma.org.uk/about/contact/

Mozza26 profile image
Mozza26 in reply to Poobah

Thank you Poobah, Asthma Uk nurses have been brilliant throughout the pandemic they kept my anxiety manageable knowing they were at the end of the phone something I didn’t have with our doctors being closed and unable to see anyone face to face. I do believe by not taking the ventolin until absolutely desperate has caused more inflammation and it has now become a vicious circle. All I know is that when I bumbled along using my ventolin and a preventer things were fine. I know that’s not how my asthma should be managed but it worked for me. Now I’m just left after trying several new inhalers with a tight chest and not wanting to take the ventolin as the way it’s been explained to me is the Relvar should be enough and if it’s not then I need help! I will also try the Buteyko breathing as this may help. Thanks again and all the best for 2022!

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Mozza26

I feel that someone has misunderstood how Ventolin works and is giving you odd advice, or communicating the situation poorly. You shouldn't *need* to use your Ventolin more than 2-3x a week because that implies poor control and a need to review your preventers.

However, this is not the same as 'you shouldn't ever need to use it' or 'avoid using it even when you need it because you shouldn't ever need it'. And if you use it and it works then no you don't need to go to hospital - it's not like an epipen!! However, generally a review of preventer medication is in order if you need to use it more than 2-3 times a week (whether or not you actually are or not - avoiding it because you've been scared off using it does not mean you never need it!) These posts have more advice on different inhaler types and when to use your reliever:

healthunlocked.com/asthmauk...

healthunlocked.com/asthmauk...

When the helpline opens up again on Tuesday you may want to give the Asthma UK nurses a ring - AUK helpline - 0300 2225800 M-F (usually) 9-5; WhatsApp - 07378 606728. They have more time than your GP and are focused on asthma so can talk you through and make some suggestions while you wait for your consultant appointment. Giving the exercises from Poobah's post a go may also help meanwhile.

Meanwhile, please don't hold off using your Ventolin because you've been told you shouldn't need it. If you are getting worse also please don't hesitate to get medical help - needing your Ventolin every so often does not mean you need hospital but if it isn't helping and you have these signs then please don't avoid hospital: asthma.org.uk/advice/asthma...

Mozza26 profile image
Mozza26 in reply to Lysistrata

Hi Lysistrata,

Thanks for all the links I will find this helpful. I was told that the Dr was not able to increase my preventer and that it would have to be a consultant in the hospital so I am now on a waiting list for this to happen even though I have been told this could take years. I feel that it would take another asthma attack involving hospitalisation before anyone will be able to increase current medication which is a scary thought. I will ring Asthma Uk as they have been amazing in the past. Thanks again and all the best for 2022!

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Mozza26

They actually can prescribe other things if they want to, though they should be doing the referral, as they have, if you need that. This link gives you an idea:healthunlocked.com/asthmauk...

Very unhelpful of them though to day it could be ages and they won't do anything else. Do you always see the asthma nurse and the same GP? Would you be able to try a different GP and see if they are any more helpful, or are they all similar?

Hope AUK are helpful - and Happy New Year!

Didn't the 'You shouldn't be using your Ventolin inhaler' start because of people only using it and not taking their steroid preventers? Thus, not addressing the underlying inflammation and ending up in hospital. As asthmatics, many of us wouldn't be here without Ventolin and I have been using it, along with steroid preventers, for about 40 years. I just think it's a shame that doctors and asthma nurses are frightening people into not using it when it's needed.

Lysistrata profile image
LysistrataCommunity Ambassador in reply to alnew45

Yes, I think there's some really poor communication going on around Ventolin! Particularly in the lack of explanation around why needing a lot of Ventolin is a bad sign but does not mean you should just not take it, or see it as for emergencies only. It seems some people, like Mozza, are being taught to view it rather like an epipen and this is not how it should be used.

I think there needs to be much clearer communication at diagnosis and afterwards about what it means if you need a lot, and when to take it. And why preventer is needed even if it doesn't seem to be doing much at first!

Mozza26 profile image
Mozza26 in reply to alnew45

I totally agree alnew45 and it’s good to know there is someone out there who has been using their ventolin along with their preventer as I used to do when I had what I thought was controlled asthma. It seems since I’ve started this new Mart regime it’s gone from bad to worse! I will revert back to my old ways and hopefully things will settle down. Thanks for your help and all the best for 2022!

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Mozza26

Hi just seen this post - Relvar is not licensed for MART! They shouldn't have told you to use it that way, though even then it seems like they just told you not to use Ventolin ever, which isn't how MART works. You're supposed to be able to use Symbicort or Fostair for extra puffs instead of Ventolin, up to a specific limit (and have Ventolin as back up). Not one puff of Relvar then 'don't use Ventolin ever'.

Mozza26 profile image
Mozza26 in reply to Lysistrata

Thank you for all your help I am shocked at how I have been mislead about this whole thing. I will certainly be asking questions on Monday with my GP. I was previously on Symbicort and Fostair and told they were preventer and reliever in one. Sorry to sound stupid am I right in saying that Relvar is not? I will contact Asthma Uk as it seems to me they know far more than my GP. Thanks again 😊

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Mozza26

Hi don't worry about sounding stupid, your GP or asthma nurse is supposed to explain this to you and it seems they have done it very badly!

All these inhalers (Relvar, Symbicort, Fostair, and some others) combine a preventer (In this case an inhaled steroid) with a long-acting reliever - a long-acting version of Ventolin that lasts about 12 hours. They're also called combination inhalers.

For some combination inhalers (Fostair and Symbicort), the lower strength ones can be taken twice a day regularly, but also used up to a certain number of times a day as needed, in addition to the regular morning and evening doses, instead of using Ventolin for quick relief (though you would still need to have Ventolin as a back up). That regime specifically is called MART - Maintenance and Reliever Therapy (or SMART for Symbicort - SymbicortMART).

But not all combination inhalers are approved for MART (Relvar isn't), and just taking one doesn't mean you are on a MART regimen. Nor does it mean you should never use Ventolin if you need it - having the long-acting reliever does not mean you can't use Ventolin.

Mozza26 profile image
Mozza26 in reply to Lysistrata

Such a detailed response which I am so grateful for as I now understand exactly what’s what. I still can’t believe that my GP/Asthma nurse has not gone into any type of detail regarding the use of different inhalers. Thank you once again for the time you have taken to explain everything 😊

Hi mozza26 i have just been put on that one but told if i found the dose or am having problems to get in touch with my ashtma nurse who can give me advice or up the dosage my old doctor told me i should be on 192 /22 but my new specialist wants to see how i go on the lower dose try to contact the ashtma nurse or specalist who put you on that one to get better advice .stay safe take care.xx

Mozza26 profile image
Mozza26 in reply to pink123floyd

Hi pink123floyd, I think after reading all the posts it is clear that the advice I am getting from the Doctors isn’t really the best. I know last year it was an Asthma Uk nurse who had to tell me what I needed and to pass it to my Doctor to get my meds changed!! For some reason my GP has told me he is unable to increase the preventer and it would have to be a respiratory consultant in the hospital and that could take years!!! I will ring Asthma Uk and take advice of them as they are always amazing. Thanks for your help and all the best for 2022! Xx

pink123floyd profile image
pink123floyd in reply to Mozza26

Hope you get the advice you need ask your doctor to refer you to a hospital consultant if your in the uk it shouldnt take long to get to see one best of luck for 2022 hope you keep safe take care.xx

Hi I was moved to Relvar 92/22 as my asthma was getting worse when I exercised. I had been on Clenil and to start with there was not much difference. I saw a different asthma nurse and she moved me up to Relvar 184/22 which she said was a better equivalent to the dose of my Clenil. I use my Ventolin before exercise and as and when I need it. I think your GP or asthma nurse can make these changes and you should definitely have an asthma plan. You should also take Ventolin when you need it holding off will just mean your symptoms are worse and mean you're more like to end up in hospital. I have found the asthma nurses more helpful than GP. Keep trying and good luck.

Mozza26 profile image
Mozza26 in reply to Jodu

Really helpful advice Jodu. I will ring the asthma nurse tomorrow and see if they can increase my Relvar as what I have at the moment is doing nothing. I was great on a Clenil for years but then just needed something a little stronger so it sounds like I’m on a lore dose of Relvar and need the 184/22. I will also be asking about an asthma plan. Thanks again for all your help 😊

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