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 use it before I brush my teeth routinely. Or if use when out, I have a drink of water afterwards to rinse my mouth. I have never used a spacer with fostair, and never had thrush.

@Bushmillsbabe thank you 😊

I am supposed to use a spacer but don’t (don’t tell my asthma nurse!). I just take twice in the morning and then rinse with water and brush my teeth. I’ve been on it three years and never had thrush, but the spacer is meant to help. I just did a clear out of the medicine draw and found the spacer still wrapped in plastic so I might give it a go to see if it helps.

I’ve been on relvar (plus tiotropium bromide) for over 12 years and am a bit worried now- is there any suggestion people need to be stepped down from it?

Ha ha. I've bought and discarded many spacers over the years, usually after GP says 'you should use a spacer'! Until I took fostair I tried and failed. to use them, I can't bear the whistle and if I suck slower, I feel lightheaded and get pre syncope.

When I was a child I had a massive spacer called a nebuhaler I think, and I can remember the smell of it now, it turns my stomach. You were supposed to wash them but I never remembered.

As it is my family are massively amused by my twice daily whistle alert 😊

I don't think so it was just part of a plan my GP & I discussed to try & rule out Relvar as an exacerbating factor for chronic cough.
It seems to me that it's very common to go up the treatment ladder to establish control but rare to go back down if good control achieved & maintained for a long period - 5 years in my case.

I was switched to fostair years ago against my wishes. I had awful side effects, shaking and palpitations and they put me back on seretide.
This year in my asthma review they pushed very hard to put me back on fostair or similar but after some discussion agreed it was the folmeterol that was the problem and all the MART inhalers contain it. So they let me keep the seretide and ventolin. I can go weeks without needing ventolin, just use it occasionally or if I have infection.

Yes. Thank you. I've already been told my error more than once, but sadly there is no edit facility.
I was unaware that a steroid was advisable to be used more than twice daily.
Given that I am allergic to Fostair, this has little relevance to me anyway.

Sorry, I didn't know that someone else had said this when replied as didn't have time to read all the posts.

There is an edit facility, but only allows you to edit for about 5 mins after posting to correct typos

Please stop scaremongering. Your GP surgery has moved you to a different treatment. This is the general trend but lots of people absolutely are still being prescribed ventolin if they need it, my DP being one of them.

I had never had thrush after years of using a brown inhaler with no spacer and being a bit slack about the rinsing my mouth out afterwards. Then a year or so back I got thrush for the first time and it was a nightmare so now I follow all the rules! Also I read a few months ago about a nationwide shortage of medication for oral thrush and that put me off getting it even more.

I also found that on the rare occasions I use my ventolin, one puff with a spacer is plenty but without the spacer I need two, so I can believe it's a more efficient way of getting the medication in.

I don't wash it often enough though

Then she's an idiot for saying that. It can be ill-advised to use solo to manage asthma, without a preventer, but you are using as intended anyway. It can become can become less effective with regular use, solo, etc. It can temporarily make your heart beat faster, but "irreparable heart damage" is nonsense.

Seretide doesn’t contain formoterol so can’t be used for MART. New guidance would advocate switching to another combined inhaler that does contain formoterol (there are several) and continue maintenance doses twice daily, plus also using this as the reliever if needed and lose the short acting - salbutamol/salamol

I changed to Symbicort so I didn't need a spacer.

Was on Fostair for years before and had inhalers and spacers everywhere (one upstairs, one downstairs, one in my workbag etc etc) and always carry a handbag big enough to fit the spacer. Fostair is much easier with a spacer.

Main reason for the swap was I wanted to carry a small designer handbag - yes, I am shallow.

Do you know whether there is a MART inhaler that doesn't contain Formoterol? I can't take that.

No there isn’t. Only combined inhalers containing formoterol are licensed for MART.

Fostair 100/6 is also available as a dry powder inhaler and can be used for MART. No spacer required. It’s called NEXThaler.

My son has been switched to the new combi ones and I don't think he would want to change back. They are working so much better for him, I don't think he would even know how to use the old ones anymore.

This is brilliant! Not shallow at all and perfectly reasonable imo. I can do a quick puff of salbutamol without anyone really noticing. But symbicort or a spacer are so noisy!

Thank you. He was only diagnosed last year so I was surprised that this treatment was considered out of date. He is doing well on his current regime though so he doesn’t need to change.

Never used a spacer with Fostair and ever got thrush. Just my personal experience.

I changed to powder inhaler years ago they are so much easier to actually inhale? I use symbicort and if goes much better into your lungs

I am allergic to salbutamol as I get uncontrollable shaking and high HR with palpitations. Relievers dilate everything rapidly, not just lungs all your blood vessels and I would have these hyperventilation episodes all the time so I am not allowed it anymore. I never get this effect on the combi

Using a spacer is to improve the amount of product that gets in your lungs, not avoiding thrush. It's much easier to use a traditional aerosol inhaler with a spacer, the technique is easier.

You can still get thrush with a spacer - but I never followed the instructions about swishing with water after and also have never had thrush.

Was just replying to @Justputsomeyoghurtonit who was concerned about thrush without a spacer and reassuring them it’s never been an issue for me.
I’ve never needed one nor been advised to use one and been great with Fostair. It’s all personal and that’s all we can share.