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 take symbicort
borrowed the blue one from a friend but didnt like how it worked, not used to it
struggling currently with the cold and having a cold, was told to keep using symbicort, so it is prevention as well as reliever, and go to A & E if needed

I tried the new combined one for a month. Had a dip in my asthma which was well managed before and asked for my old prescription and got it, no problem.

I've had my review and I was reluctant to change. They said I could trial it, or remain as is, and it was up to me. No mention of salbutamol causing heart issues.

I've had various steroid inhalers over the years and still needed the blue reliever. I've had the reliever one for nearly 40 years, and I'd say over the past year I've use it daily, sometimes more than once (not just the past year, just using that timeframe).

I agreed to try the combi one (Luforbec) and I've barely had to touch the reliever. I've been told I can still have the reliever if needed, no warnings about any issues.

I read that the opposite - for over 12’s, prescribe a regular MART if their asthma is not currently well controlled with occasional only use combi therapy.

Personally I’ve been on Symbicort for about as long as it’s been available and find it much better for my asthma in general. My issue is my pharmacy are going through a phase of only putting 1 inhaler in my meds each month despite the prescription being for 2, and I have to chase them for the 2nd one every month - especially at the moment when I’m using it 4 times a day instead of twice because I’ve had flu/have got a chest infection!!

I was on a combined one (seretide) for a while but then went back to separate ones though can't remember why, but as long as I remember to take my flixotide every day I almost never need the ventolin (I've used it maybe twice in the past year, when ill) so separate means I get much less of the reliever so surely better.

Is this only for over 12s? My 7 year old has the blue and brown inhalers.

Totally appreciate your reluctance. Both of my children who are old enough were on the exact meds you are, and changed to the new one you’re being offered. They say it’s so much better and they’re so happy they changed.

Personally, I think you should report her to the head of practice. Saying this without fully backing up the evidence, could have catastrophic consequences, by making somebody afraid to use the reliever when they or their child need it.

I don't doubt that habitual long term use of the blue inhaler is not a good thing, but scaremongering in this way is putting people at greater risk of a serious or potentially fatal attack.

I will continue to carry my Ventolin in my pocket when I walk my dog. I almost never need it, but the risk is still there, so it gives me peace of mind.

I’m on fostair, montelukast, spiriva and the ventolin accuhaler. I also regularly need prednisolone. I saw a nurse practitioner at the doctor’s a few weeks ago because I was having a flare up with a chest infection. I don’t know if she had asthma as a specialism, but we went through all my drugs and she didn’t say anything at all about ventolin no longer being prescribed. I get it on repeat prescription without any difficulty. Maybe it being an accuhaler (dry powder) makes a difference. What she did say though is that they no longer prescribe rescue packs because they don’t want patients putting themselves in danger by inadequately self treating. For years I’ve always had spare prednisolone and antibiotics at home because I need to act very quickly if I can feel a flare up or chest infection coming on. I’m slightly alarmed by this, but would be far more alarmed by not having ventolin available when I need it.

I got an asthma diagnosis in my 40s (none in childhood). I was prescribed Pulmicort as a preventer and Bricanyl as a reliever. I request the reliever so rarely that it was removed from my repeat prescription (had to request it was re-prescribed) and I've been advised to request one every 6 months (although I can ask the pharmacy not to dispense it if I don't need it). I only requested a new one because it had gone out of date! At my asthma review they said that because my asthma is so well controlled there is no reason to change medication, it's only advised for those who aren't stable.

Agree with this.

I didn't realise lurbofec/lurfobec (sorry, can't remember how to spell it) was a version of fostair. I got changed from fostair to lurbofec a couple of years ago and I think fostair was better as it didn't irritate the back of my throat when taking it. Although i started using my spacer again and that really helped.

My mil wasn't impressed though. She came home with her new inhaler that she proudly said was very special and exclusive for extremely ill people. She said I had probably never heard of it. She was very disappointed to find out I had been on it for ages!

The change is based on numerous studies as part of the global initiative to prevent asthma deaths . The main cause that was seen was overuse of salbutamol only medication , either with inadequate preventer or no preventer use . As someone up the thread explained the use of salbutamol provides short term relief but doesn’t treat the underlying inflammation whereas using the combined medication provides both.
The studies also showed that regular use of salbutamol ( not to excess ) using more than 3 full inhalers per year and certainly using one inhaler every month led to increased inflammation in the airways and less response when the inhaler was used in an attack
Overuse has always been associated with changes to heart rate and arrhythmia
The understanding of what causes asthma has changed over 50 years when it was thought of as just a restriction of the airways which should open up again with salbutamol to being aware that everyone with properly diagnosed asthma will have some airway inflammation
The use of combined as both preventer and reliever in the studies showed a significant reduction in asthma deaths

Salbutamol is still prescribed and is still recommended in some regimes as a reliever but for a lot of people the evidence is to use the combined inhaler instead when you would normally be reaching for salbutamol.

it is not a cost cutting exercise as salbutamol and clenil are a lot cheaper!

I have been on a combination inhaler for about 10 years and my asthma is much better controlled than it was. My GP surgery did try and change it to a new ‘improved inhaler’ but I declined as happy with mine. Not very helpful as I don’t know what that medication was but I currently use DuoResp Spiromax.

Ask to be swapped to the dry powder version.

Yes, I think you’re right.

My asthma is stable, I can’t remember the last time I used my reliever inhaler. So I think by default I’d be staying on my current system.

I agree with your point about multiple inhalers. My asthma is well controlled, to the point that I don’t think about taking a reliever inhaler with me. So on the odd occasion I do have a problem I like to have reliever inhalers squirreled away in the car, around the house, in various bags, etc. I used to get two at a time for this purpose.

There's some really bad advice on this thread. Do not ignore your asthma review, they'll just refuse to issue you with prescriptions until you attend, which will be stressful to sort out. Don't try and stockpile Salbutamol/ Ventolin inhalers that will make it look like your asthma is really badly controlled.

I take Fostair along with Montelukast tablets in winter (my choice I could have increased my dosage of Fostair instead, but wanted to try the tablets). I agree with most people on here that the Fostair is far better than the older preventer I used to take. I also have a Salbutamol inhaler that I use very occasionally, they are happy to prescribe them, but if you are ordering too many they will want to increase your other medication, as you're not considered to have your asthma under control. What I understood from the asthma nurse was that they become less effective if used to often and mask symptoms of uncontrolled asthma.

OP I can understand you being reluctant to change something that is working for you, but maybe give the combined inhaler a chance and see how you get on. You can always ask to change back if it's not right for you.

I was also moved over to a generic alternative which triggered rather than helped my asthma. GP's can prescribe fostair still, but they have to show that have prescribed the cheaper alternative and it wasn't effective. Mine switched me back after my peak flows showed as significantly worse on the generic

@User0012944 my peak flow improved as I got fitter ( aerobic exercise - cycling and circuits) but was particularly helped by me joining a choir and singing a lot!

I've been told this isn't an option, it is this or nothing which is why I feel so stressed about it. Clenil and ventolin (not that I need the ventolin) will be unprescibeable

Mine is much better managed on fostair. I don’t even need to take it daily, a couple of times a week is fine and seems to keep it under control. I have to admit I hadn’t heard anything about the ventolin being dangerous!

Blimey this makes for scary reading.

DC2 (11yo) has recently had her annual asthma review (October 2025) and nothing was mentioned? I wonder if she'll be given another review next time I order a repeat.

She only uses her blue inhaler when poorly with a cough (a few times per year now her asthma is well managed. She used to get coughs every 6 weeks before that) and then she only uses the blue inhaler for a few days.

Thank you that gives me some reassurance. I didn't ever even think about my asthma on Fostair so I'm really hoping they switch me back at my appointment.

I switched to this system a while back - I now use my preventer for both prevention and relief (I’m on Fostair). It’s made a big difference. My peak flow has improved, my control is pretty much perfect and I got through the coughs and colds before Christmas with no issues whatsoever. I don’t miss ventolin at all, and fostair doesn’t give me the horrible palpitations and light headedness that ventolin could. Apparently mainland Europe has been using this system for years and the UK was way behind them in terms of asthma control.

Then I'm fucked. I've been using a salbutamol every month for the last 30yrs!

Fostair does not do the same job IMHO.

Ha I did wonder why I had two invitations for an asthma check up mid-year. I didn't go as I'm absolutely fine.

I currently have a fostair and salbutamol. I'd prefer to go back to serevent/qvar which worked well for 15yrs.