Fostair

[Q-owl]

As Fostair may lead to adrenal deficiency, could it be responsible for the flare I've been experiencing since taking it in September? I had reduced to 2mg pred stable over 2 months. One month taking 1mg and ok, even trying 1 day a week on zero pred, during the summer.

The respiratory nurse (I've had a series of chest infections) has reduced my prescription for pred to 1mg daily, and commented that the steroid in Fostair should increase the steroid effect for my PMR.

My autonomy to control my medication has gone, but using my stash I've been taking 2.5 & 2mg unsuccessfully try to control the flare.

[SnazzyD]

Do you mean a PMR flare or adrenal insufficiency symptoms? Any inhaled steroid could make the adrenal gland reduce its output of cortisol because it is being supplied by the inhaler. However, this is at a much much lower dose and extent to oral steroids. I’m not sure they can use your Fostaire as an equivalent in order to deduce the Pred, not least because your absorption is going to be unpredictable.

A PMR flare might be happening because your steroid need overall is either too low for your PMR activity that may have ramped up because of the chest infections not the Fostair. Or, your symptoms are due to low adrenal function or both these things. What are your symptoms.

I don’t think it is the business of the nurse to mess with your rheumatological medication like that. If it is adrenal insufficiency have they given you guidance on how to recognise a crisis.

[SheffieldJane in reply to SnazzyD]

I so agree with this. It’s lazy of the nurse. If you are in the midst of a chest infection that is being treated by Fostair, I would still be inclined to support this treatment with sick day rules for my Adrenals. Can you check with your Rheumatologist or the doctor who is the lead on your PMR? Look at FAQs for sick day rules guidance. Basically a temporary increase by 5 mgs of Pred for a week to 10 days. Then back to your normal dose. The nurse’s advice may spoil your very good taper.

[Q-owl in reply to SnazzyD]

PMR flare, difficultly getting out of bed, can't move the lower limbs. Hip pain, general stiffness, which wanes after painful movement. OK for most of the middle of the day, while I'm active, but returns after sitting down for any length of time.

[SnazzyD in reply to Q-owl]

Sounds like your corticosteroid dose isn’t high enough if you are getting breakthrough symptoms.

[PMRpro Ambassador in reply to Q-owl]

Definitely sounds like a flare due to too low a dose of pred - almost certainly due to the nurse's interference. It was nothing to do with her.

[Q-owl in reply to PMRpro]

You're quite right! I'm continuing on 2mg and hoping the flare will sort itself out in the heat. I'm flying long distance on Sunday. (2 months with family in Manila). I'll double my dose tomorrow in anticipation. If I run short of UK pred, I'll have to hope I can get some over the counter in the Philippines.

[PMRpro Ambassador in reply to Q-owl]

I'd go to a pharmacist here and try on "I've lost a packet - help ..." Just in case! No way you'll get help from a GP before you go is there!

[Q-owl in reply to PMRpro]

I'll give it a go!

[PMRpro Ambassador in reply to Q-owl]

They can only say no ... And you can't be left without on a 2 month holiday can you!

[piglette]

As SnazzyD says Fostair contains corticosteroids so it should not make the adrenals any more insufficient. It does sound to me that your current does is not high enough if you have been having trouble since September. I don’t blame you increasing the dose. I would try and get a higher dose prescribed as the others suggest.

[PMRpro Ambassador]

Fostair contains a corticosteroid - no different from pred. It is the longterm use of inhaled steroids that may suppress cortisol production in exactly the same way. But that is not what causes PMR.

I think your respiratory nurse is in cloud cuckoo land - the inhaled steroid is nothing like as effective as systemic pred for the PMR. You are in a flare because she has taken it on herself to interfere with a specialist doctor's area of expertise.

[Longtimer in reply to PMRpro]

Methinks cloud cuckoo land is now getting extremely full!....

[PMRpro Ambassador in reply to Longtimer]

Is that why there are so many left here?