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?

I know it can cause an irregular heartbeat if over used, but that resolves a while after discontinue use

I never wanted to change from Seretide and Ventolin as I had been on them for 30 years and I swore by them. I was also on monteleukast, and another inhaler that I can’t remember the name of.

However, last year I changed to Symbicort (combined inhaler), and it’s been a complete game changer. I take it morning and evening and I couldn’t tell you the last time I needed my inhaler. Nothing triggers me anymore, and I am running half marathons without needing an inhaler once.

I’m the same as you OP. I genuinely cannot remember the last time I used a blue inhaler. I take my preventer every morning and I’m fine.
No doubt I’ll have to follow the new guidelines but it sounds like I’ll be getting more of the blue stuff than I have done in years.

Yes, it’s the irreparable bit that’s worrying me!

Looking it up it seems Ventolin is more environmentally unfriendly that the combo inhalers (one Ventolin being the equivalent of a 75 mile car journey) and that’s one of the reasons they’re being phased out. Along with masking inflammation as a pp explained.

www.ukmeds.co.uk/blog/is-ventolin-being-phased-out-in-the-uk?srsltid=AfmBOooeMP-dWKnPeX7DMyKKuZTi7p1h3WommJ3hs7rt8mPBKhoyCuFK

I moved to Fostair around 8 years ago and it's been brilliant for me, one puff twice a day and generally feeling great. Unfortunately last month at my asthma review I was told that for cost purposes the NHS is moving people over to Bibefco which apparently has the exact same active ingredients. A few weeks in and I'm not getting on well at all. Whole I'm not ill, I'm waking up with a tight chest and by bedtime very much feel the need to take it again, a feel a constant low level tightness all day - it's made me realise just how good the Fostair was.
I've made another appointment to review it again as I'm not happy with it at all. I appreciate the strain on NHS finances is very real but I won't be happy if I have to continue with it

What are your symptoms if you take ventolin?

I have Fostair too. Much better than the old brown inhaler. Using a spacer has also made a big difference.

I was told the damage can be irreparable. Makes me feel very uneasy there is either no consensus or hcps are lying

I’m reading the guidelines: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations#inhalers

Looks like there was a main update Nov 24, and some revisions Nov 25.

“1.7.3Offer low-dose MART to people aged 12 and over with asthma that is not controlled on a low-dose ICS/formoterol combination inhaler used only as needed. [BTS/NICE/SIGN 2024]”

My asthma is mild. I read this to mean I’d be using a combined MART (maintenance and reliever therapy) but only when I feel symptoms (“as needed”). Which is a change.

I was moved to a Symbicort combo and it was great, until I had an asthma attack. I couldn’t for the life of me suck hard enough to get it in my lungs. Fortunately I still had a Ventolin on me and took that. I asked the asthma nurse and she said it was fine to do that in an emergency.

My Mum’s been taking Ventolin for probably 50 years and is absolutely fine so I’ll hang onto it until either I’m dead or they stop making it!

I mean I don't think it could possibly be cheaper for me? I am currently on Clenil 100 200 dose inhaler which is £7.62 and then I get about 1 blue inhaler every year £1.50. I use 2 puffs a day so it currently costs them about £30 per year, or a little less.

Edit: I mean cheaper for the NHS in my circumstances.

"Clenil Modulite"
https://bnf.nice.org.uk/drugs/beclometasone-dipropionate/medicinal-forms/#:~:text=Hide-,Clenil%20Modulite,-100micrograms/dose%20inhaler

"Ventolin 100micrograms"
https://bnf.nice.org.uk/drugs/salbutamol/medicinal-forms/#:~:text=Ventolin%20100micrograms

Fostair is £30 for 1 120 dose inhaler, so I would need 6 per year, so £180.

https://bnf.nice.org.uk/drugs/beclometasone-with-formoterol/medicinal-forms/

I have been ignoring my asthma review because my asthma is well controlled currently - I reckon I use my reliever every 2 or so months, and only once or twice.

Has there been a NICE guidelines change does anyone know? I will go away and Google now.

I've been on a combi one for years because I'm allergic to the blue ones.

It's brilliant and my asthma has never been so controlled.

I understand its frustrating but there are always advances in medicine and they will eventually fade out the old ones.

I'm still on Serevent (green) and Clenil (brown, steroid). I had terrible side effects from Fostair when they tried me on it a few years ago, it gave me the most horrific migraines and blurred vision. I'm not due my asthma review for ages but I might have to book in to see the nurse now I've seen this.

I’m following this. I’m on the red inhaler Duo Resp/symbacort. I have been using this for quite a few years as I wasn’t getting on with the salbutamol. I’ve got an appointment later this week for a review as I get repeated chest infections.

Fostair is more expensive so it's not about cost cutting, the blue and brown inhalors are cheaper. But a pp has said she's been moved off Fostair because of the cost and onto a less effective generic.

I'd stock up because they won't prescribe it anymore

I really cannot find any evidence of lasting heart damage from reliever inhalers.

Loads of evidence of short lived tachycardia (I get this, so I have a Bricanyl inhaler instead of Ventolin/Salbutamol). But nothing lasting.

I think it’s more likely your HCP is misinformed.

That makes sense, but the person I was replying to said they had been moved onto a combined inhaler (from blue and brown) because of the cost.

Thanks! I’ll order some more online.

I use Fostair as my preventer but I still have a ventolin. Fostair is great but I haven’t heard anything from the surgery about stopping using a blue inhaler - I guess they’re updating as people do their reviews. Thanks for sharing op, I’ll do a bit more reading!

Fingers crossed! Can you ask them OP? You’re freaking people out here.

I was prescribed Fostair, but it gave me really bad shakes. I've gone back to my yellow relvar one which works better for me. Has anyone experienced this.

Also, my daughter and son, 10 and 12 were given a ventolin for what I think is asthma, although not officially diagnosed. They only use it for breathless which is rare. Will they be ok to use it ? I guess so if it's been prescribed to them?

I’m another voting for Fostair which I’ve been using since 2013 combined with montelukast at night. It is a brilliant combo and having started taking montelukast two years ago when my asthma was poorly controlled, my peak flow improved by 200 points in TWO DAYS!

@User0012944 i was swapped from brown/blue to a combined one years ago. It was life changing (in a good way). The combined one has a lower amount of steroid in and a tiny amount of a longer lasting reliever.

DS takes Symbicort and Montelukast, and still has a Salamol reliever.

We increase/ decrease the dosage depending on (seasonal) risk level/ triggers so have space to increase dosages when he feels symptoms becoming noticable before they ecalate to being an issue. It's nearly 2 years since he had to use the Salamol to relieve attacks. He is susceptible to falling into complacency during stable, symptomless phases and this system works better for him than the old Clenil preventer.