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 just had my annual Asthma review in December and they never mentioned anything to me. I have been on Fostair for about 7 years now after my Asthma got worse during pregnancy.

They also told me to take the blue inhaler if I need it but don’t use too many puffs. I don’t use the blue inhaler very often though as my Asthma is generally mild and well controlled.

From the guidelines here: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations#inhalers

“People with an existing diagnosis of asthma who are stable on their current therapy do not have to switch treatment.”

The keyword here is “stable”. If you are having attacks (or ‘exacerbations’ as they put it) then it might not count as stable.

I’ve clicked through and looked (briefly) at their ~1000 page evidence review and it looks sound. I think this is very much evidence based and rooted in improving patient outcomes.

There is consideration to cost and environmental impact (remember the move from aerosol to powder inhalers not long ago), but this is based on clinical evidence of improved outcomes for patients, and trying to reduce death by asthma attack. Which I’m all for!

I’ve been on ventolin for years. It’s the only thing that works for me. The doctors tried moving me to one last year which put me in hospital as it was useless. I’ll be staying on ventolin as there’s no evidence in the papers or anywhere regarding it .

I’ve been on seretide for like, forever. Since I was first diagnosed with asthma, which would have been 20 years ago now.

they definitely are prescribing it and giving it out because this week myself, my mum and my partner all got a ventolin inhaler from 3 separate pharmacies. Please don’t be scaring people saying you can’t get it.

I have felt so much better on Fostaire. I used to be hospitalised 2-3 times every year and also on nebuliser too. Now as long as I don't forget to take the Fostaire pink inhaler I feel fine. It's like a miracle. I'd never want to have to rely on blue inhaler again.

Lifelong asthmatic here 🙆🏻‍♀️ I got put on the new one at my last asthma check up and have had a few clean up calls with the pharmacist to see how I’m getting on. I was quite concerned at first especially to find out how bad the previous inhaler could be (been on it for many years) but as with all medicines and conditions, research and science find that things can be better. Unless you have a reaction to the new inhaler I’d follow medical advice.

I think you’ll find that the MHRA have said ventolin can no longer be prescribed as an automatic repeat prescription and this is to avoid uncontrolled asthma. If you feel you need ventolin, you must request the prescription, which will trigger a discussion with your nurse/GP to ensure you’re on the best treatment for your asthma.
This is for asthma patients and not COPD patients from what I can see.

Again I was put on Symbicort two years ago. I had an asthma flare with oxygen sats of 91% and two weeks of steroids, two weeks antibiotics and a refused hospital stay (didn't want to be admitted to the hospital I work in).
Was put on Symbicort and montelukast afterwards. I have been on it two years- and my asthma is much improved. Rarely have an attack- and have stopped taking montelukast as my night time saturations have gone from 93/94% too 98/99%. Brilliant drug....

I was changed to Fostair a few years back and it’s been brilliant. I only take 2 puffs a day in summer and 8 if I have a virus or it’s really cold. It’s allowed me to exercise. Change is not always bad!

I used Relvar for a year or so but noticed my heart rate was permanently higher (just as I assume it would be if I used Ventolin every day) so asked to stop. I went back to Clenil and started paying better attention to always using a spacer, and I've been fine. Mostly I only use my blue inhaler very occasionally - it probably averages out at 1 or 2 times a week. That said I did feel amazing on the Relvar apart from my heart rate being regularly over 100 (it was already a bit on the high side).

Is there such a thing as an exercise regime that can permanently increase peak flow? I hate the fact that even my baseline peak flow is so low (about 350) compared to everyone else in my family.

I was originally on the steroid inhaler and blue salbutamol. I took the blue one before I exercised as I was told to. They then moved me on to the combined one and I do notice a difference in my swimming. My breathing while I swim is noticeably easier.

I was put on Fostair about a year ago (the asthma nurse explained that ventolin had been around for 30+ years and was outdated now), and it works well for me (I also take montelukast which was a game changer about 2 years ago). But yes Fostair also makes me shaky and my heart beat faster, for about an hour after I take it. I told the nurse and he said that isn't anything to worry about. I only take it once per day for this reason though.

My daughter is on Symbicort (since two years ago) and it’s brilliant but she was given ventolin for just in case. Maybe that’s changed.

What alarms me about this ventolin being dangerous information is how hard it was ten years ago to get a GP to agree to her being on a preventer. Being asthmatic myself I knew she had asthma so pushed for Clenil but friends’ children have had ‘ventolin when required’ for years.

Mostly I only use my blue inhaler very occasionally - it probably averages out at 1 or 2 times a week.

@Screenadelica To me that sounds like quite a lot. I certainly wouldn’t consider that “very occasionally”. When was your last asthma review? Uncontrolled asthma is defined as using your reliever inhaler 3 times a week so it sounds like you’re hitting that some weeks if 1-2 times per week is your averaged out figure?

I haven’t needed my Ventolin inhaler even once in at least the last 6 years. I take the dry powder Seretide 250 Accuhaler. My asthma nurse rang me before Christmas about the new guidelines and wanted to change my prescription to something else and I said no, why would I change when this is clearly working well for me? She agreed with me so we didn’t change anything.

I’ve moved to combined and my asthma is well managed. Dd still has the blue and brown ones and she’s 14 🤷🏻‍♀️

I don't disbelieve it but I havnt heard it either! And I had an asthma review in the beginning of December. They kept me on my blue inhaler

I was placed onto the red one at my last check for these reasons, didnt really think much of it, once a day was much easier than as and when although the strength did make my voice hoarse for a good month! There was no more panic at not finding an inhaler, no more waking up at night, i forgot i even had it tbh.

Now im usung the blue due to weather whilst i wait for my prescription and my god can i feel the difference! So combi has been great for me - cant really understand why people are getting crossI

@TesChique
Well I suppose I'm "getting cross" because I had terrible side effects from the combined one. But thank you for your compassion 🙄

mine were changed to fostair a couple of years ago but still get my blue reliever, it's now salamol instead of ventolin which I believe is the same thing, just a lower carbon footprint apparently.
I am much better now than I was when I was on the pink clenilone I took for years, I hardly ever need my salamol now.
They did try me on relvar first but I really hated that one and couldn't get on with it at all.

It's probably a bit less than that even - quite a lot of weeks I don't use it at all. Also, I never need to use more than one puff (with spacer).

I'm another who was told to switch at my last review, with no reason why other than "updated guidelines". Given I rarely use my blue inhaler (salbutamol) unless I've got a cold, I feel my asthma is well managed and a bit of discussion/explanation might have been nice (although fat chance of that at my surgery).

As luck would have it, I'd picked up a repeat prescription of my beclometasone a couple of days before, so using that up before switching, but the comments about Fostair have given me a bit more confidence.

A question though - my pharmacy were storing it in the fridge, and it says it's not to be stored over 25 degrees. So what do you do if you're out and about in the summer? Or is that a nice idea but unrealistic and doesn't really matter too much? As I said, being able to discuss this with the asthma nurse rather than being told "I'm changing your prescription because there are updated guidelines, go and pick it up from the pharmacy" would obviously have been helpful in answering this point!

This was the phrase I mentioned during my consultation when I tried to argue that I felt it was better I stayed on my current inhalor and I was told that is not what it said and I was mistaken. I'm finding it very upsetting that this hcp appears to be making several false claims.

I'd love to know if there were exercises that can improve peak flow too... and also re heart rate, a lot of these combined ones have warnings for people with high BP but the clenil doesn't.