Symbicort Inhaler

[Geegee2]

Hello, advice please. I was diagnosed with asthma last May after being free from it for over 40 years. Have never seen a doctor as all doctor appointments were over the phone. I was initially given ventolin which helped a little but could not breathe properly and was taking it every 4 hours. After 4 weeks I was given a symbicort inhaller 2 inhalations twice a day and after two weeks symptoms disappeared. Have not had to use ventolin since. On Monday my Doctor phoned reviewing my medication and suggested I reduce the inhalations to one twice a day and see how I go. I welcomed this because I now do not sleep well which I believe may be a symptom of the steroids. At the same time I am a little nervous because the thought of struggling for breath frightens me, especially with the pollen season approaching. Sorry for the long post just wondering if anyone has followed a similar path? Thank you.

[Troilus]

I had a similar thing. I was on Fostair 200/6 and after 3 months was reduced down to Fostair 100/6. I didn’t do so well on this and so it was upped again to the 200/6 dose.It could be that you are fine on the lower dose and if it doesn’t work out for you as you know the higher dose works for you, you should be able to move back on to it. You always have your blue inhaler should you become symptomatic and there is a delay in seeing your GP and getting a new prescription.

I think it is that the guidance says that asthma should be managed on the lowest dose of ics, so once the asthma is well controlled it is not unusual to try stepping down.

I think in my case things were a bit clouded because I had had a few courses of prednisone in the three months prior to the reduction.

[Geegee2 in reply to Troilus]

Thank you for responding Troilus. May I ask how long you were on the reduced dosage for before you had to return to the higher one?

[Troilus in reply to Geegee2]

4 months. But my peak flow started going steadily down after 6 weeks.

[Geegee2 in reply to Troilus]

Thanks again. Useful to know.

[Hidden in reply to Geegee2]

I too am on the higher dose of fostair and wanted to reduce my steroid dose. My consultant suggested reducing from 400mg twice a day to 300mg twice a day to start with. I was fine for about 6 weeks and then had an asthma exacerbation requiring oral steroids, so a bit of a useless exercise for me. But I note you are halving your dose....as you can see I was doing it much more slowly. I only wish it had worked, but you don't know until you try. Always better to be on the lowest dose necessary to keep you stable.

[Geegee2 in reply to Hidden]

Thank you stobes93. Sorry it didn't work for you.

[Gareth57]

I've been on a various inhalers over the years but have been on Fostair 100/6 for maybe 10 years until a couple of years ago it wasn't working so well from late autumn to late spring so after speaking to a doctor we trialled using 200/6 over that period and back to 100/6 for the summer which is working well so far, so you can always increase again if pollen becomes a problem (with approval from the gp of course).

[Geegee2]

Thank you Gareth57. Really useful to hear others' experiences.

[Rostom]

Hi Geegee2

Long-term asthmatic here, also on Symbicort 200/6 2 x twice daily.

Are you recording your peak flow twice a day? I find this (basic 'though it is) helpful, as it shows when you are 'going off the boil' . For example, if you are well and taking your Symbicort and your peak flow is, for example, 400 each time but you drop to one Symbicort twice a day, and your peak flow also drops, you have 'proof' that the reduction is not enough for you .

Sometimes these drops are not significant for a day or so but if there is a constant reduction in your peak flow, you need more help. You should not be using Ventolin to support the Symbicort. The Symbicort is supposed to keep you well with the adjunct of Ventolin only when necessary - not as an everyday/all the time product.

Ask your GP or perhaps there is an 'Asthma nurse' at your surgery (they can be very helpful) who can give you a peak flow chart but if not just make one from a grid, recording your peak flow readings morning and evening. This gives you concrete evidence of how you are and can be shown/read to a health professional.

You should also have an 'Asthma Plan' which explains what you should do in an emergency (how much Ventolin to use etc.) It may help you if you think you may have a sudden major problem. Again, ask at your surgery for one.

I take your point regarding the hayfever season etc., as I, too suffer but please do speak to your GP regarding antihistamines. These may or may not be available in the UK from your GP as many health authorities have removed them from prescribing lists and they are have to be bought OTC (over the counter). If this should be the case, please look on-line as on-line chemists sometimes do exceptionally good deals on antihistamines, far less expensive than high street chemists.

Please don't flounder with your asthma, it can be a dangerous problem and you need better management. Your post indicates that you may need a higher dose of Symbicort but of course, I am not a doctor. Speak to your surgery and request a peak flow chart and an Asthma Management Plan and a review of your current Symbicort doseage.

Hope you feel better soon.

[Geegee2 in reply to Rostom]

Thank you Rostom. I do note my peak flow twice a day and with the inhaller (100/6) twice a day I average 600. It has been 6 days on reduced dose so it is early days. I do not have a plan or an asthma nurse so thank you very much for the advice.

[Wheezycat]

I am on Frostar 200/6 twice daily. One of the GPs suggested last April I reduce it as he couldn't see I needed such a high dose. He wasn't my usual GP - this was while the pandemic was playing quite a lot of havoc still) He suggested I halve it, and we agreed it is probably a good idea in the summer, but not so in winter. I didn't feel I got instructions how to halve it, so I contacted an Asthma UK nurse who strongly suggested I should reduce with just one inhalation and then wait three months before reducing again. As I started late I didn't have time to reduce more before autumn and winter set in.

Probably sometime later this month, once it is properly warmer, I will start reducing again. But as someone else said, it seems much wiser to do this gradually, rather than by a hefty amount in just one go.

[Geegee2]

Thank you Wheezycat. Advice does seem mixed. I will follow your example and phone Asthma UK.