British Lung Foundation
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My first post

 I was diagnosed with mild COPD in 2009 and given a steroid inhaler, Seretide.  My COPD is now moderate and I have just had my inhaler changed to Spiriva which is leaving a nasty taste in my mouth so I am not sure about it so far.  My GP wants everyone to stop taking steroids if possible.  I have never smoked so that is not a problem.  My consultant said he thought it might have been caused by tuberculosis which I suffered from 48 years ago.

Luckily everything seems to be stable now and my life is fairly normal apart from getting tired after walking for half an hour.  So only worries are side effects of inhalers and occasional chest infection, one a year, so very fortunate so far. 

I have worries about the future but many of your posts are very reassuring so I thank you all for that.  My location is Yorkshire.


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Hi as far as I am aware seretide is different to spiriva and should be given as well as - not in place of.  Spiriva is a longer acting bronchilitator which you only take once a day.  The purpose of this is to strenghten the lungs and is a longer term one.  x


Thank you for that.  The other inhaler that was discussed is called Duaklir.  Do you know if that one is better?  I understand that it delivers two medicines as Seretide does.  I have been advised to stop the Seretide.  This has occurred because of a pharmacists comments!  

Don't know this one I'm afraid but others might be on it.   You usually have 1 preventer - seretide,  symbicort etc.  which you use twice a day.  Then you should have your reliever - blue ventolin which you use as and when needed.  Then many also have a longer acting bronchiatior like spiriva to be taken once a day.  x


I had Seretide and a blue Ventolin which I rarely used but visited surgery after spirometry to discuss stopping Seretide because it was a steroid.  Duaklir and Spiriva were mentioned and I was persuaded to take the latter but assured that I could go back if I was unhappy with it which I think I will do shortly to discuss the options of Duaklir, which is new, or returning to Seretide. 

Like many others on the site fed up of pharmacists  who are being put under pressure by their companies questioning me.  My husband will collect my prescription in future alternatively I will either say no thank you to pharmacists or if I say I am not prepared to sign anything, which I did last time they do not want to talk to me.

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You will find pharmacists taking on a bigger role in your care as the government try to ease the pressure on GPs.My  pharmacist is excellent.D.

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The pharmacists I meet Farmer simply wish to repeat the assistance already given by either the nurse or the doctor.  They lose all interest when I point out that I am not prepared to sign anything.  I am of the opinion that they are just milking the NHS rather than caring got me.

Blue42eyes Ii have the same inhalers as you the doctor told me to always gargle water after you've inhaled it will stop the thrush and dryness at the moment im having trouble with small blisters around my mouth think I need some cream x

Thank you for the advice.  I will try that.

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Hello, my late mum never smoked but she had severe copd thought to have been caused by 2 episodes of TB in her 30's & 40's. She as me, had 24 hour Spireva and 12 hour Symbercort. Take care x 

Yes, my consultant said the tuberculosis which I had when I was 26 caused the COPD and that may be correct but I have also read that the treatment used at that time, streptomycin, caused it.  I don't know the truth but I do know that if I had not had the streptomycin I would have died at that young age.  So better to stay alive and have COPD later on in life. Easy choice and I am very fortunate.

Thanks for letting me know that both of you were prescribed two drugs that is most helpful and I realise that I must question this new reductioin in treatment.


Mum was prescribed Streptomycin injections &  PAS . These were the new miracle drugs of the 1950's;  not long before this time people usually died. I think Spireva was a revolutionary copd treatment; I think it helps us be more active, rather than cooped up all winter. X

My TB was in the 1960's and I too had PAS like your mum.  I was delighted that life afterwards returned to normal and lucky that it was around 40 years later before the COPD appeared.  I saw several other patients die whilst I was in the hospital.

My COPD is classed as moderate and on the Seretide I did not have any problems unless I took a long haul flight and I assume this is related to recirculing air on aircraft.                 

Do you take Spiriva only?  It sounds to be working for you.

I am feeling anxious because of the change.

I am on both Seretide and Spiriva and found the dryness went away after a few weeks but was annoying as I am on the phone at work most of the day. I always have them at breakfast with a big mug of tea which i drink after breathing them in.

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Thanks.  I have tried mouth wash which did not change anything but I will get my cup of tea earlier.

Thanks, I must ask about that as lots of posts on this site seem to indicate two inhalers.

Seretide contains a steroid and long acting bronchodilator. Spiriva is just a (better usually) long acting bronchodilator. If it works well for you, bad taste is usually an easily managed side effect - mouth wash etc. or as said it may disappear in a couple of weeks as you get used to it. There are worse ones that MAY affect a user, like impacting your digestive system, sinusitis, PND -  which are much harder to deal with. 

I have never had an inhaler other than Seretide before so I think I have become very nervous about it all as it was unexpected, probably should give it a try for a bit longer and see how I feel about it.  It is more difficult for me to inhale than Seretide.

I take  Spiriva and have a sip of water that seems to work for me 

I use seratide 250x2 twice a day and ventolin. Tried symbicort but it gave me horrendous reflux dont know why. 

I always eat with my seratide as it gives me reflux and mucus a bit tis strange. 

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I have suffered with reflux for quite a while but ever connected it to the Seretide.  I have often experienced a problem shortly after I have gone to bed or part way through the night.  This site is really helpful.  Thank you Wartonk.

Hi,your doctor is right about steroids,causing me stomach problems although they do help with breathing.Gargle after inhalers cuts the nastiness.Welcome,D.

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Yes, with a bit of luck I might be able to enjoy food and not have to take  half a bottle of gaviscon afterwards.  An exaggeration re the gaviscon but I have bought lots and failed to connect the stomach upset with the Seretide.

Good for the reflux and heartburn is a table spoon or both Honey and Apple Cider Vinegar mixed in hot water let is cool then have a sip or mouthful as required  was sceptical at first but does work really well and quick.

I was on symbicort, taking one puff in the morning and one at night. I had seen Breo Ellipta mentioned on another site I visit, and asked my doctor about it. She had never heard of it so phoned the chemist. He said it was available here in NZ. I got some to try, and it really works good. One one puff per day, and no thrush, which I used to get with symbicort. Apparently there is another replacement for Spiriva, Spiriva Respimat. The dosage for this is in a spray form and easier to take than normal Spiriva.

I think the Breo Ellipta is similar to the Duaklir that was mentioned to me.  I find the Spiriva less easy to take than the Seretide.

Thanks I have tried the Ellipta Genuair now but it gives me a headache around five am and does not subside until I am vertical i.e. after I have had breakfast and moved about.  I thought it might be better than Spiriva but the taste left in my mouth is even more unpleasant.  I cannot manage this as I am too tired at work.  Awakening at 5am is not a problem but being unable to doze for a couple of hours is tiring.

Unless you have a particular issue, the standard NICE recommended treatment for COPD is a reliever (eg Salbutamol) plus a dual action corticosteroid/long acting bronchodilator preventer such as Seretide. I suspect you are unwittingly a victim of NHS cost reduction policies. Seretide is a very expensive combi-drug and lots of users have been "encouraged" to change to cheaper ones like Symbicort or Fostair. I was changed on to the latter some 6 months ago from Seretide and find it a good one with minimal problems. There are always issues with taking steroids but the combi inhaler is still the recommended procedure. You need to know why the so-called professionals are recommending you drop it.

It was changed as a result of a recommendation from the pharmacist I was using as they have been asked to do this by the government.  There is a a fee paid by the NHS for this service but I think that is collected by the pharmacy eg. Boots, Lloyds and so on rather than the pharmacist.   I don't know if the pharmacist gets a payment too or not.  He made a recommendation despite the fact that I declined an offer to talk to him about my prescription.

I think the final decision over which inhaler I have may still be in my hands but my GP also said that he wanted everyone off steroids.  However I don't think this issue would ever have arisen if the pharmacist had not intervened.

Your comments sound completely feasible and it seems that I should do some research in to what is happening.  Thank you.

Spiriva is only a supplementary drug supplied as well as a dual action preventer not instead of. Not every COPD patient has Spiriva but they almost all have a dual action preventer like Seretide which is expensive. I was offered 2 alternatives when asked to consider a change and initially rejected Symbicort because it is a powder and I don't like any of these. I then trialled Fostair which is an aerosol and costs about half as much as Seretide and found I got on well with it, so was happy to change to it. I've never had Spiriva. I think you need to be strong and demand the recommended NICE treatment, but also offer to change from Seretide to a cheaper alternative.

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Thanks Warwickstag I have no particular issues.  The nurse says that she is concerned about seretide because of the side effect of pneumonia which I already knew about.  However, there are side effects with all treatments eg. the Spiriva and Ellipta inhalers can affect the heart so it is 'swings and roundabouts'.  The nurse said last week that my prescription would not be changed until I was happy with an alternative.  I have tried Ellipta Genuair which gives me very early morning headache and results in me being tired all day.  I will ring surgery next week to see what, if anything is suggested.  I assume Symbicort and Fosrair are also steroids which I am advised that I do not really need as my problems are caused by scarring rather than inflammation as in asthma.

Never heard of a doctor saying he wants everyone off steroids if you need them. If you need them you need them crazy docs advice. Defo push it Blue!! 

Yes does sound very strange and I will be back at doctor in a week or two.

There is another alternative to Spiriva, Spiriva Respimat. This gives the dosage as a spray.

•The dose of tiotropium is different depending on which inhaler device you are using.

•Dry powder inhaler (Spiriva Handihaler®): ◦The dose is 1 tiotropium capsule inhaled once a day.

◦Inhale the powder in the capsules using the Handihaler device. Do not swallow the capsules.

Metered dose mist inhaler (Spiriva Respimat®): ◦The dose is 2 puffs inhaled once a day.

•Tiotropium is a long-acting medication which means that its effects lasts for 24 hours.

•Follow your doctor's instructions carefully. The pharmacy label on your medicine will tell you how much to use, how often to use it and any special instructions.

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