To not want to change my medication (new asthma guidelines)

[User0012944]

Just that, aibu to feel very reluctant to change my asthma medication when things are going so well.

Apparently according to new guidelines out last year, everyone with asthma now needs to be on combined inhalers. I've previously been on a brown preventor for years and years and have a blue reliever just in case. Which I never take. I accept there is new evidence which shows the blue inhalers, (salbutamol/ventolin?) are very dangerous, but if I never take it it is not an issue surely. Being on a combined inhaler would give me a daily dose of whatever the substitute drug is for the "reliever" component, but why am I being forced to take this additional drug when I never use my reliever and fine on my preventor. I've also tried to read the new guidelines this is all based on and I'm obviously not medically trained but it doesn't seem to be what it actually says.

Am I being unreasonable for wanting to stay on my current inhaler?

Is there new evidence that the blue inhaler/ventolin is very dangerous?!
Hadn’t heard that and worried now!
Where did you hear that OP?

My DH came back from his asthma check up this week very cross for similar reasons. His regime has worked for him perfectly for many years and last year he was praised for it. A year later, they’re trying to change it all for no clear medical need.

Can I stay on my seretide inhaler?

Asthma nurse says it causes irreparable heart damage, arrhythmias etc. I use it very rarely anyway, only if I've been forgetting to take my preventor but I'm far better at that now than when I was younger.

I understand your reluctance. I was moved from the same inhalers you are on to a combi one. I noticed side effects after taking it (shaky hands mainly) but also an huge improvement in my breathing. The difference was I was walking around with poorly managed asthma and not knowing it and then when I swapped I realised how poorly managed it was. This isn’t to say the same is true for you but I would book in an asthma review and discuss treatment options and look to review a month or so later. I’m so glad I switched as I had been on the brown inhaler for years and now I can exercise more (even jogging which I could never do) and breathe a lot better. That said, I would push back if your asthma is currently well managed.

Mine was changed a few years ago onto this. I was very reluctant and they also wanted to put me on montelukast which I said absolutely not as the side effects were awful and comes with a warning in some countries.

I changed and now Ventolin doesn't work at all. It is bizarre.

I really did try and discuss it. My asthma is well managed, they did test with a little car and a long exhale which confirmed there was no inflammation

I’d been on my brown and blue inhalers for about 35 years. I wasn’t keen to change but am really glad I did. I hadn’t realised how much my asthma control could be improved - my peak flow is massively improved and to the first time since I can remember I haven’t been reliant on the reliever inhaler through all the winter coughs and colds.

What inhaler are you taking now?

Since being on fostair I’ve felt so much better. I take that twice a day and never need ventolin. It also has no shaky feeling. I do high level sports and my aerobic capacity is great. I understand reluctance to change but for me it’s been a blessing moving from the old brown/ blue combinations.

Another who moved to Fostair over 10yrs ago, I don’t feel asthmatic anymore. I can exercise, walk in the bitter cold and wind, be poorly without struggling to breathe etc. I don’t regret changing at all. And I’ve never had any bad side effects from the combined inhaler.

That is odd. I guess if the main argument is the risk factors then it may be worth considering, but my question would be the risks of switching to a combi inhaler.

For reference I’m on Fostair but I can still use Ventolin as a rescue inhaler (or the Fostair) right now, but I’m due an asthma review. So it replaced my brown inhaler.

As far as I understand it, they are seen as dangerous as they give short term relief but do nothing about the underlying issue. So someone could be having a flare, keep taking the blue one but inflammation in airways keeps getting worse, and then reaches a crisis point where they are so bad the blue one isn't working anymore. It lulls people into a false sense of security that they are ok when aren't. It's also quite short lasting.

Whereas the combination inhalers work on the MART protocol (maintenance and reliever therapy). So if you are having a flare you increase dosage from 2 to 4 times a day, the steroid brings the inflammation down and the reliever gives short term relief - but lasts longer than blue inhaler. I used to be on the brown plus blue combo, averaged 2-3 hospital admissions per year for asthma, plus a couple of gp oral steroid courses.

Since moved onto combination inhaler (Fostair) I have only had 1 admission in 5 years, and 1 oral steroid course.
The one bit of advice though is don't let them put you on the generic Fostair, called Luforbec I think, it's awful, made my asthma much worse.

I too was reluctant to change. I only used my old blue ventolin in winter when I had a cold. But I’ve had the new combined one a few months. And am currently taking it just twice a day. I am two weeks in to having a really bad cold / flu that’s knocked me off my feet. I’m coughing loads but it’s not settled on my chest as it usually does. I think it may be the new inhaler .

Irreparable damage? Wtf? Worried now.

I was also very sceptical but IMO Fostair is amazing. Hardly feel asthmatic. Only thing that persists now is my cat allergy * sobbing *

I was told nobody at my practice is to be prescribed it

I've been on fostair for years (allergic to ventolin!) and it's brilliant

I was lap forced to change last year and was worried about it. Day to day I feel lots better, but have had two hospital episodes in the last year. That might have happened anyway, I don’t know. But I think they’re the experts so if they’re telling me not to use ventolin then I won’t.

As far as I understand it, they are seen as dangerous as they give short term relief but do nothing about the underlying issue. So someone could be having a flare, keep taking the blue one but inflammation in airways keeps getting worse, and then reaches a crisis point where they are so bad the blue one isn't working anymore. It lulls people into a false sense of security that they are ok when aren't. It's also quite short lasting.

I understand that aspect of it but OP is saying she’s been told by her asthma nurse that they cause irreparable heart damage!! That’s extremely alarming if correct.

I was told that shouldn't use ventolin with fostair - fostair contains a reliever which works as quickly but lasts much longer.

Are you absolutely sure??

i was moved from the blue and brown to a combined one, but the asthma nurse told me it was to save money, ie one inhaler not two.

Salbutamol should only be used 2-3 times a week at the most routinely. So if not regularly exceeding that and on an inhaled corticosteroid it is safe. For those worrying about irreparable damage

I could not find any reference to this at all.

It seems more that instead of reliever inhalers being given in the first instance, people are being given a combined reliever/preventer inhaler.

I get the impression that many people are less good at taking their preventer regularly and so miss out on the prevention, relying on only the reliever, an so get into difficulty more frequently and more severely.

If their reliever is also a preventer, at least they get some prevention/steroid effect too. Which means the next attack is less bad.

I can see how this is desirable at a population level.

But I don’t think I want a reliever in with my preventer. But my asthma is quite mild, I rarely use a reliever at all. And I like to be in control!

That being said, I’m happy to be corrected. Please do share any sources to the contrary.

I went on Fostair about 8 years ago and it's much better than the brown preventer. I was also taken off Ventolin at my asthma review last week. I was told to use Fostair if I need a reliever.