Asthma - Turbohaler, Symbicort

[francohoops]

Hi. Our son has been on a brown inhaler (2 puffs a day) for around the last 5 years. He's now 13. His asthma has been well managed (he had a flare up about 18 months ago, which we think was pollen driven and he ended up in hospital).

Since then he's had no further issues and his Asthma Dr has recommended he move to a Turbohaler, Symbicort (100/60). Her advice is to start with 2 puffs a day for a few weeks and then ease off it, only using it at the first sign of any issues.

Has anyone any experience of using the Turbohaler? Just wanted to reassure myself that this is the best approach, and if he needs to use it then it acts fast enough to relieve any symptoms.

Thanks in advance
F

I have it, it can be used as preventer and acute although at my last review I was given a blue one too. I used to do twice a day . Now once unless I have a cough.

Ds has this as a daily preventer, and the normal blue reliever one as and when needed, which is hardly ever.

I have this one -2 puffs twice a day and more if o have a cold/hayfever and any other triggers.

It’s a long acting preventer, unlike the ‘brown’ one.

it’s advisable to have a drink of water after taking it as it can irritate and cause a cough.

I use turbohalers- I use the brown one every day (2 puffs daily upping to 4 if there is a lot of pollen or other triggers). I rarely use the blue turbohaler (the last one went out of date and I'd only had a few puffs from it!) They are much easier to use than standard inhalers- just a big breath in. Very handy if you are having an attack and need to use the blue one!!!!!

I’m an adult with adult recurrence of teenage asthma and had a couple of A&E admissions in the last 3 years due to exacerbation of asthma mainly due to chest infection. I have been on Symbicort 400/12 for about 20 years and I’m generally well controlled on being able to drop my dose from 2 puffs twice a day down to one when well. I have been told not to stop completely but, if unwell, I can also increase my dose to 4 times a day.

Hopefully your son will find it beneficial
and will control his asthma better as he progresses through his teens.

DD uses it in the morning and evening but still has a blue one for out and about.

She's never had a bad asthma attack but gets out of puff in the cold or during exercise. She says she prefers the Turbo inhaler than her old brown one.

thanks, I guess my concern is completely dropping all medication, and only using the Turbo as and when needed. I know this should be a positive (as DS is very excited), but just concerned that the Turbo won't work in time when symptoms start

It’s been my main inhaler for years. It’s really easy to use and can be used as a preventer and a reliever. That said, I do like to have a blue inhaler for emergencies even though I rarely need it.

I briefly switched to a cheaper alternative (cheaper for NHS that is) but didn’t like it. I’m afraid I can’t remember what that was called

Would definitely recommend Asthma + Lung UK for information about the inhaler and the condition generally.

https://www.asthmaandlung.org.uk/symptoms-tests-treatments/treatments/combination

https://www.asthmaandlung.org.uk/living-with/inhaler-videos/turbohaler

Whilst the red symbicort inhaler does keep symptoms at bay, I too still keep a blue inhaler for emergencies -a handful of times in 20 years.

Perhaps ask your GP if your son can keep his blue one.

I have a different inhaler but the same regime. It's both a preventer and a reliever.

Has been fantastic for me as I used to have a collection of different inhalers which I regularly forgot to use, and weren't working that well when I did remember.

Went down to just one inhaler for everything and most of the year I don't even bother taking it everyday. If my asthma flares up I can rapidly increase and get on top of it.

Google MART regime, maintenance and reliever therapy.
Although I'm sure the guidance is if you have had an asthma exacerbation you should remain on an inhaled steroid which symbicort contains, Budesonide (as well as the long acting 'reliever' Formoterol ) twice daily for at least two years.
I wouldn't be too quick to ease off it until then.

@francohoops Hi, I'm a respiratory specialist nurse and asthma is one of my main areas.

The Symbicort Turbohaler 100/6 can be used as a preventer and reliever (so your sons old brown and blue together). It's important to note at a "Turbohaler" is the type of inhaler device, and doesn't suggest which drugs are in it, whereas the "Symbicort" is the drug information. I only mention this because other people may be on a "Turbohaler" but it may contain different drugs to the Symbicort.

I suspect your GP has suggested starting this for a number of reasons. The guidelines identify that patients who have had a hospital admission in the last 12 months should be stepped up, and also because it can be used as a maintenance and reliever inhaler (MART like a pp mentioned), it can actually therefore be used in quite a low dose of inhaled steroid.

The "100" is the steroid and the "6" is the reliever.

In someone with asthma, the steroid part of inhalers should never be stopped / weaned down / eased off totally. Only under very certain circumstances. So I suspect that your GP meant to wean down to the minimal dose possible. Starting at 2puffs twice a day is the equivalent steroid dose to what your sons brown inhaler would have been so it's reasonable to start here to get used to the new inhaler, and then it can be reduced to one puff twice a day if he doesn't have any symptoms at all - but usually step down after 3 months.

If you son has symptoms during the day, he can take an extra puff as required. Maximum of 8 in a day.

As previously pp has mentioned, make sure he rinses his mouth out.

Depending on the type of brown inhaler he had before (if it was a puff one?) this may be a different technique for him as it's a dry powder, so please make sure you and he watch a Symbicort Turbohaler video on asthma UK or RightBreathe to make sure the correct technique.

Hope that all make sense, please let me know if you want any more info.

I should also mention - there is a large movement across the UK at present to become "greener" with inhalers. So a lot of areas are actively moving to use dry powder inhalers rather than the pump / spray / puff inhalers.

However, if you feel that his technique is not right / he does not appear to be getting relief from the inhaler / doesn't get on with it / gets a sore throat or mouth or thrush etc. Please please go back to the practice. Whilst the green agenda is important, there is nothing more important than making sure people inhalers are effective and giving them the one that best suits their technique. If your son doesn't have a deep enough breath in, then the Turbohaler style will not sure him.