Seretide vs Piriva = confrontation

Hi all,

I recently posed a question about seretide 250 which I was prescribed with 6 months ago, bad side effects with tearing skin, bruising, weight gain etc ( it was also affecting my sex life ) and actually received 51 replies and I would like to thank everyone who replied. A number of you questioned why I was on such a high dose as I am supposedly mild copd with a fev of 72%. One of you kindly sent me a link to a medical paper ( which i printed out) which stated that seretide 250 is prescribed to patients with a fev of 60% or less. showed that to my Dr. and he completely ignored it

Yesterday I had a follow up with him since being diagnosed and I questioned as to why I am on a steroid and why such a high dosage and asked if I could try 50-100 instead. To which I received the reply “Thailand no have”. I then mentioned Ventolin which a number of you suggested, again “ Thailand no have”. He then asked me if I was a trained doctor, to which I replied no, so he then said….so listen to me then, not other people.

Whilst I agree with his diagnosis of asthma which is not copd, I am not sure about the chronic bronchitis as I have no cough, no mucus and no phlegm, but he has diagnosed me with copd stage 1.

I am supposedly at around 72% but this is not conclusive as I am unable to put the spirometry tube in my mouth…I am a gagger and have to be sedated even for dental treatment, but from the reading I was able to give and listening to my lungs I was diagnosed as stage 1.

Unfortunately it ended with a bit of a confrontation as he wanted me to carry on with seretide, but I wanted to try a non steroid. In the end we agreed on a trial of Spiriva ( double the cost) and would be interested in hearing from those who are using this as I know there are some side effects, but not as bad as seretide.

Hopefully the Spiriva will work, first dose this morning, otherwise I am going to end up with egg on my face.

As I am unable to give a 100% spirometry test we have also agreed to a CT scan which is scheduled for next Friday.

Is a CT scan more accurate than a spirometry test?

He did start to tell me that my bronchial COPD will keep progressing even though i have not smoked for 6 months, so i reminded him that in 3-5 years hopefully medication will be released which will halt the progression to which his reply was rubbish, stop reading the internet. So i ended the conversation by by telling him that i know of a senior pulmonary nurse who is going to a conference in New York later this year, the basis of this conference being this new medication and reminded him that in his profession he should keep up to date. Not looking forward to our next meeting.


20 Replies

  • Oh dear, Merv: what an awful doctor's consultation that was. I do hope the Spiriva does the trick for you.

  • Hi Eregendal, unfortunately i am stuck between a rock and a hard place as there are only 2 pulmonologists on the island, different hospitals but same company owns both, so they share patient information as i am registered at both.


  • Hi swerv, I can't speak for the seretide, never been on it. The Spiriva I take every morning at 7 am, Im only 3 months diagnosed copd and just into my 2nd month taking spiriva, with 43% fev1. I can say (for me) the spiriva has been brilliant, I can manage my days with ease. The difference between this and what the ventolin was doing for me is massive. I don't need the ventolin at all.

    I do hope you find the same and I wish you well. Shame your dr isn't more supportive. good luck.

    Jjude xx

  • Thanks Jjude, first dose this morning, so will see how i progress.


  • What an arrogant man your consultant is Merv. Him being one of only two consultants, he obviously thinks he's all powerful. I feel for you.

    I hope the Spiriva works better for you. The man's a tyrant. xx

  • Thanks Casper, unfortunately i have to put up with him, the alternative is to fly to Bangkok.


  • Hi Merv

    What a prat of a doctor....I wonder if he is related to my GP !!

    I am so pleased you put him right, the pompous little git !!

    Now.... I Have Asthma and COPD....and I take Spiriva and Symbicort, ( I also have Ventolin, which I never use apart from a real emergency, as it makes me cough and gives me oral thrush, even after rinsing my mouth and throat )

    I get on great with both...and apart from when I have an infection, I still manage most things within reason.....My last Fev was 50%.

    I hope it works for you, and lets hope the CT scan will give you the right diagnosis.

    Take care

    Velvet xx

  • Thanks Velvet,

    I am going to go to a few pharmacy's as i don't believe ventolin is not available here. Just need it when i have an attack whilst out. Had one just as i walked into tesco last week, was able to sit down and do some pursed lip breathing and was fine in about 5 minutes. But it would be nice to have something that would give immediate relief.

    Must admit i took my first dose of Spiriva this morning and feel fine.


  • Yes, good idea to visit pharmacists. Ventolin. Is used internationally so I'd be surprised if is isn't available on your island. Don't forget, the ingredient is Salbutamol. I used a version called Breathe-Easi (or Easi-Breath). Also, it's not on licence any more and is available in the UK over the counter.

    I'm on seretide 250 for asthma. There is also a 125. In the summer I take 125 in the morning & 250 at night when airways are worse.

    Re a CT scan, I think it's marvellous for diagnostics, it will show any emphysema and it will show any damage there might be - and also if your lungs are beautifully clear, definitely worth knowing. Be sure you have a look at the ct pix when they're available. P

  • If it is available over the counter then i will, be very surprised if it is not available here. I will be doing some searching next week.


  • I hope you get on OK with the Spiriva. I take that although some days when the weather has been mild here lately I've not bothered and not really found any difference. I am supposed to have moderate COPD (diagnosed with a FEV1 of 63%). Like you, I have no cough, no mucous or phlegm, the only time I get those is if I have an infection or if my resident Pseudomonas flares up. All I have is breathlessness which is worse when cold and windy or having to walk uphill. I can't do fast walking (good job I have a plodder/sniffer of a dog :) ). Remember to rinse mouth out with water afterwards, also gargle, to prevent thrush. I have had no side effects from Spiriva but have with every other inhaler I've tried. Of course we are all different.

    Like I said in your previous post, no idea why you were given a steroid inhaler. Personally I would challenge whether Ventolin (or any other brand of Salbutamol inhaler) is available in Thailand. Google "is Ventolin available in Thailand" and you will get links, one of which is that same question asked on Trip Advisor, admittedly from 2011 but shows that it was available then so probably is now , other links may help further.

  • Thought i would let you know that ventolin is freely available here. Doctor lied to me coz it is so cheap. Bought for about 3.50gbp.

  • Hi Seaside susie, thanks for the links, as i thought, freely available here. In fact supercheap is where i was going to look, it has a huge pharmacy, probably the size of a small supermarket and you can buy just about anything there...and cheap. I will also check the cost of Spiriva as my hospital tends to be about 60% more expensive than outside.

    Day 2 of my Spiriva and already noticing a difference. Normally SOB in the mornings, today...nothing. I feel good.


  • Hi Merv, well done for challenging the doctor. I take spirava and seretide 500 so I am an expensive patient drug wise as my pain relief is dearer too but they are best for me. So I wish you good luck with the spirava, I have no major side effects, so hopefully it will work for you. Hopefully by your next visit to the doctor you will both be able to build a new relationship in respect of managing your illness. Almost forgot I have never been in hospital for my COPD, so the treatment for me is good, just wish I could resolve the constant cough.

  • Hi Katie, fortunately i don't have a cough which is why i have questioned as to whether i have copd or not.

    I will find out next Friday as i am having a CT scan.


  • I am on seretide 500 and speriva my fev1 was 57% last year I have all ways had a cough and for the past few years I have been breathless all the time no amount of antibiotics or steroids will clear it I go back to the hospital in October I dont think you have copd

  • Hi Bless,

    I suffered for several years with Asian flu, twice a year and each time was diagnosed with Asthma/Bronchitis. I then started to have a fruit smoothie in the mornings and did not have flu for 4 years. But then developed a smokers cough early this year which then became a permanent cough. It was then that i was diagnosed with copd.

    My FEV was 72% but was not 100% accurate as i could not put the breathing tube in my mouth... i am a gagger.

    Anyway, will find out on Friday when i have my CT scan.


  • Interesting. I have been on various inhalers etc., over the past twelve months, none of which seem to work, Seretide, Fostair and Spiriva included. My FEV1/FVC is about 60-63% on each test, although my FVC is gradually falling over time from around 3.55 litres to around 3.2 litres - a 10% decrease in a year, about 65% of predicted I think. I have been told that I have "probable" obliterative bronchiolitis, and even though I am relatively free from infection, and have been for over 18 months, I am getting progressively more breathless. I have chest expansion problems caused by Ankylosing Spondylitis. I have been on Humira for about 10 months now, but was told by the rheumatologist that we wer probably too late to stop the decline of the lungs as most of the spondylitis is burnt-out ( although I have had recent increase in back pain which woud suggest that inflammatory activity is still rife).

    I certainly cannnot walk up a hill, and I get tachycardia (around 110-130 bpm) from walking up one flight of stairs. At 49 years of age, that is not promising, and when I read about obliterative bronchiolitis, it does not bode well, often being associated with post-operative transplant rejection.

    I am not quite sure where to go. I have been on Prednisolone 20mg for a fortnight, then 15mg for a fortnight, then, 10mg, then stepping down by 1mg every fortnight - now down to 4mg; I was told to remain on the dose that made the breathing easier; well none of the doses have made the breathing any easier; does that mean that when I go back to the respiratory consultant in December I should tell him that the dose was not high enough, or that we are just wasting our time. My stomach has ballooned, even though I have been able to keep the weight gain to a minimum.

    Well I am now going to go and enjoy the Supermoon, the last one that I am likely to see, but what the hell!

  • Hi Merv

    Sorry about your situation but I've just googled salbutamol which is the generic name for Ventolin and Salamol (same but different taste!) and it is available in Thailand, according to them.

    The other alternative is to buy online ...

    Good luck with the nasty piece of work you're dealing with but don't give in - it's your life not his!

    Jude 😉

  • Hi Jude

    I think the reason he did not want to prescribe ventolin is because it is not as expensive as Spiriva...medications are marked up about 60% here in international hospitals and the docs get a %.

    I have a huge pharmacy near me which stocks just about everything you can think of, i am sure i will find it there. Will also check for Spiriva as i paid about 60gbp for 30 capsules.



You may also like...