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 was told it only has to be stored in the fridge until you start using it, then it can be kept at room temperature.

I was on Seretide & ventolin until I had my asthma review, wanted to change me to Forstair, I was very reluctant to change, but…… very pleased I did, rarely need to ‘top up’ on blue ventolin as I used to.

Does anyone have any experience of Bufomix?
It’s what my 15 year old has recently been prescribed. She used to be on Becotide and Ventolin. The Ventolin inhaler has still been prescribed along with the Bufomix, but I’m hoping she won’t need it as much (or at all) now. I asked for a review as I felt she kept ‘forgetting’ to use the brown inhaler (Becotide) and was consequently using the blue one (Ventolin) too much.

I've nearly died from asthma several times, spending a lot of my childhood and parts of my adulthood in hospital with it. Even today a chest infection can become life threatening very quickly. Basically I know severe asthma.

I've been on salbutamol for fifty years, asthmatic since birth. Forced on to a million briefly trendy alternatives at various points (Spinhalers anyone?) Various brown steroid inhalers.

I've not needed either since I switched to a Clinell. It's the best my asthma has ever been managed. I was equally cynical about switching (another miracle cure, great) and I'm still prescribed salbutamol. Never use it any more. When my asthma is bad I just use it more as advised by GP/asthma clinic. More doses means more steroid. Years and years since I've needed a nebuliser, let alone gone to hospital.

You can easily go back if you don't get on with it and nobody is making you throw your traditional inhalers away.

I've been asthmatic for nearly 40 years & was happy on Seretide Accuhaler for many years until had a flare up & was put on Fostair via a spacer. Absolutely hated it - tremor & fast heart rate so put on Relvar. Was happy on this but as no flare ups/infections/oral steroids for 5 years & peak flow stable have been stepped down to Clenil via spacer with Bricanyl Turbohaler when required. Only 10 days in but so far so good - no need for Bricanyl but aware washout of Relvar might take longer than 10 days. Also had montelulast trial a few years ago but felt no benefit so stopped it.
So Clenil & Bricanyl/salbutamol still being prescribed.

I'm not sure I understand. You said you get on with Clenil, so do I, I wish to remain on Clenil. You're saying nobody is making me throw my traditional one away - what do you mean, after I've finished it and it is empty? They're saying I can't have any more

I had the same experience with the generic version of Ventolin - GP’s explanation was that, while the drug is the same, the propellant is not

Bufomix seems to be very similar to Fostair in terms of active ingredients. Seems a very sensible option based on your description - as long as using Bufomix rather than the ventolin as a reliever, as then will be getting the steroid dose automatically whenever uses - not perfect as might not be as regular as is ideal, but better than using the ventolin which contains no steroid.

In terms of remembering - my fostair lives on my bathroom shelf and I use before brushing my teeth twice a day.

It makes no sense that they gave her ventolin aswell though - Bufomix contains folmeterol which works as quickly and effectively as ventolin but last longer.

The steroid is a preventer, not a reliever and it isn't intended to be used as such. I use Serevent and Clenil currently. The Serevent is also a long lasting reliever but is only intended to be used twice daily and not as needed, it is used in conjunction with the Clenil which is the steroid.

This is the difference with Ventolin, it can be used as needed rather than as a twice daily treatment. The combined inhaler is a treatment, not a reliever.

This is an interesting thread.

I have, like many others, also been on Fostair for a few years now. I get on ok with it.

The nurse told me it was because new research shows the blue ones cause our lungs to be lazy?????

No idea what to believe now!

I got changed to symbicort only at my last asthma review
Was working ok until I got a chesty cough cold a few days ago and can’t breathe as I have no rescue alternative
Managed to get a GP appointment and was diagnosed with pleurisy and prescribed steroids and antibiotics - I asked about rescue inhaler but was refused and told current advice is to stick to Bricanyl twice a day and not allowed a rescue option but to visit A n E if it got worse
Really struggling but don’t want to spend hours in A n E - see how things are tomorrow

Thank you. It is a bit confusing as it seems it can be prescribed for different reasons. Looking it up I found the following:

“Your doctor will prescribe Bufomix Easyhaler for you to use as either:
• an anti-inflammatory reliever medicine only,

• both an anti-inflammatory reliever and a daily maintenance preventer medicine; or,

• as a daily maintenance preventer only, where another medicine is used as a reliever.”

The reason why it says this is because it depends on the dose of inhaler , so lower steroid dose versions are licensed for AIR therapy which is the first one described, this is when you only use the inhaler when you need . Years ago this would have been salbutamol which was given but as recent evidence shows this is incorrect manage . MART is the next one described which is when the inhaler is used as both the preventer and reliever. The last one likely applies to the high dose inhalers - the very high steroid mix ones are only licensed for preventative and hence a separate reliever will be prescribed

your daughter should be on one of the lower ones and it sounds like they’re suggesting to use it like AIR which means if she needs an inhaler she takes the combined inhaler and not the salbutamol usually up to 8 puffs per day

This thread is interesting and I think I might ask our asthma nurse how she is explaining the change to patients. It is a completely different way of managing asthma compared to the past and our pharmacist has recently been stopping salbutamol in patients on AIR and MART systems but not on other regimes so salbutamol will not go away .
children may be on different regimes as the use of inhalers as described above is not licensed under 12s but we have been using with sensible older children

Thanks @FelicityBennett, but it doesn’t always just depend on dosage I think. At least, the insert leaflet with DD’s inhaler (one specific dose) says it’s prescribed in two ways. Sometimes it’s prescribed as the only asthma inhaler (and is also used when relief is needed) and sometimes a separate reliever is also prescribed.

My Dh and DS have the blue inhaler. I had no idea it was dangerous.

the blue inhaler isn’t dangerous when used as it should be used ie as part of an asthma plan and only very occasionally
Its just that there is a lot of new evidence showing safer ways of managing asthma and in the past people have been too reliant on salbutamol because it does help at the time you take it but it’s not actually stopping the inflammation and hence this way of taking the blue inhaler has been linked to worsening asthma because of the lack of steroid controlling the inflammation.

Dont stop using it if it is prescribed for your DS but if you are worried about asthma control then make a appointment

It isn't dangerous if used as intended. Please do NOT stop using it on the back of this thread. It is spreading misinformation that could have catastrophic consequences.

No. Recent change, over 5 years old can now use MART if able to use the device - Symbicort turbohaler. If stable on blue - and brown children can stay on this regime.

The combined inhaler, as long as it contains formoterol, is also now used as a reliever too. That’s the idea of MART, maintenance and reliever all in one device.

Yes, sorry, I stand corrected. That has since been explained.

When I was given Fostair I was unaware of this but the GP took me off it after 3 days because of horrendous side effects.

I have a combined red one and it’s far superior to the old set up.

In case no one has answered this yet, seretide is a preventative and a long acting reliever in one so I doubt they would change you if it's working. DS had an asthma review before Christmas and they said nothing about taking him off his seretide.

For those of you just using fostair... Do you use a spacer with it? I always need mine in my handbag and there's no way I'm using a spacer on the train or in the office. But it's supposed to give thrush without a spacer.

I don't mind using a spacer when I use it morning and evening at home.

Yes, I googled it after reading this post and the NHS website says it is a safe and effective medication. Very dangerous message to send, my DH has had periods of really bad asthma. I'm pretty sure he would have been dead without the inhaler.

Under the MART protocol it can be used as both. Its stands for Maintenance and Reliever therapy, and Fostair is the only inhaler I use. I use twice a day as standard, but during a flare I use the same inhaler up to 4 times a day, which has the benefit of increasing the steroids to manage the underlying flare and relieving the immediate symptoms. It dramatically reduces the need for oral steroids, which can have serious side effects if used to frequently. Folmeterol (the reliever in fostair) works as quickly as ventolin but lasts as long as Serevent.

Using ventolin does nothing to address the underlying flare, so can mark symptoms without addressing them.