Tag Archives: inhaler

Medication 101: Flutiform

This is my second post that I am going to do for Medications 101 but this is the first post I will be doing on an Asthma Medication.

I have been taking Flutiform since March 2014 so about 9 months now and so far it has controlled my asthma the best out of every inhaler I have tried to date. Flutiform is a preventer inhaler meaning that it is used to reduce the inflammation in the lungs, therefore reducing asthma symptoms, and hopefully preventing attacks. Flutiform is also a combination inhaler meaning that it contains 2 different medications, one of which is a steroid used to reduce inflammation in the lungs, and the other is a Long Acting Bronchodilator [Long Acting Beta 2 Antagonist… AKA LABA] which is used to relax the smooth muscles in the airways therefore reducing symptoms of asthma. LABAs work for approximately 12 hours [except for Vilanterol which works for approximately 24 hours and therefore only needs to be taken once a day] and are used to help reduce the amount of Short Acting Bronchodilators [Short-acting beta 2 antagonist… AKA SABA] such a Salbutamol [Ventolin] and Terbutaline [Bricanyl] that a person needs.

The steroid component of Flutiform is Fluticasone and the LABA component is Formoterol.

Flutiform tends to be indicated for use in people ages 12 or older with moderate to severe asthma more so than in people with mild asthma, where the use of a steroid inhaler alone doesn’t control a persons asthma.

Doses:

Flutiform is available in 3 different doses; the 50/5 [containing 50mcg of Fluticasone and 5mcg of Formoterol], the 125/5 and the 250/10. Most people take 2 puffs twice a day through a spacer however your doctor will decide the best dose for you.

I have been on the 125/5 and the 50/5 doses mainly at 2 puffs twice a day but I have been allowed to increase the dose of the 125/5 inhaler to 2 puffs 3-4 times a day [could also be taken as 3-4 puffs twice a day] in an attempt to avoid prednisolone during a flare… and it worked!

Precautions:

Flutiform isn’t indicated for anyone who is allergic or hypersensitive to Fluticasone or Formoterol or any of the ingredients that Flutiform contains [see section 6 of this leaflet].

You should also speak to your doctor before taking Flutiform if you have or have had TB [Tuberculosis] in the past, if you have a chest infection, if you have any heart problems, if you have an aneurysm, if you have diabetes, if you have high blood pressure, if you have an overactive thyroid, if you have low levels of potassium in the blood, if you have poor adrenal gland functioning or if you have liver problems.

You should also talk to your doctor about before taking Flutiform if you are taking certain medications including beta-blockers, theophyllines, adrenaline and adrenaline-like medications, additional LABAs, some antihistamines, some high blood pressure medications, some heart failure medications, some anti-depressants, some antipsychotics, some anti-fungal medications, some anti-virals, some antibiotics, some Parkinson’s medications, some medications used to treat an under active thyroid, certain medications used to treat Hodgkin’s disease and some medications used to induce labour.

Side effects:

[I have indicated the side effects that I have experienced with an asterisk]

Uncommon side effects occurring in approximately1 in 100 people include:

  • increase in blood glucose level
  • worsening of asthma
  • headache
  • shaking *
  • irregular heartbeat or palpitations *
  • dizziness
  • changes in voice/hoarseness
  • dry mouth, sore/irritated throat
  • swelling of hands, ankles or feet

Rare side effects occurring in approximately 1 in 1000 people include:

  • thrush
  • inflammation of sinuses
  • fast heartbeat *
  • muscle spasms
  • coughing or shortness of breath
  • diarrhoea
  • indigestion
  • difficulty sleeping
  • agitation
  • rash
  • high blood pressure

Pros:

+ Many of the side effects are quite mild

+ There are quite a few other combination inhalers available if this one isn’t the right combination for you

+ Can be taken through a spacer as it is an aerosol which increases medication delivery, while reducing the risk of thrush

+ There is some flexibility in doses

Cons:

Is not available in the US or Canada

Is only available as an aerosol

Sources:

  • Patient information leaflet [See here]

Do you know what inhaler you are on?

I have just been reading a blog post on Asth.ma [a blog by an Asthma Researcher at Harvard] about how a lot of people don’t know the names or doses of their inhalers whereas they often know the names of the other medications that they take e.g. Enbrel, or Methotrexate. And it has really got me thinking about 3 conversations I have had in the past couple of weeks.

A few days after I had moved up to uni I found out that one of my flatmates has asthma, and being naturally inquisitive I asked her if she was on any sort of preventer inhalers, to which she replied that she was on the purple one… I knew she meant Seretide/Advair and I didn’t really think that much of it because so many people know their inhalers by colour rather than by their actual name that I wasn’t that concerned. I wasn’t even that concerned when I found out that she didn’t even know the dose of her inhaler, but I could see just by looking at it that she was on the 125/25 Seretide inhaler. The next week I had 2 similar conversations with two other people from uni, both of which had asthma severe enough to be on an inhaler corticosteroid combined with a LABA [Long acting beta antagonist]. One girl identified her inhaler as being red and white – meaning that she took Symbicort, but she didn’t know if she was on the 100/6, 200/6 or 400/12 dose, and the other said that her preventer inhaler began with an “R”… We later identified her inhaler as the new Relvar Ellipta inhaler using google.

At the time I didn’t think that much of it, but if either one of these 3 people has any sort of emergency or ends up in a situation where they need to identify their inhalers they are going to have a really tough time. 2 of them didn’t even understand why they were moved off of Clenil [AKA the brown inhaler] and onto an inhaler containing both an corticosteroid and LABA… They both said that their doctors/asthma nurses had said they need to take something stronger but hadn’t gone into any detail about what the “something stronger” was. Am I the only one who finds this remotely worrying? Absolutely not, and the point was well highlighted by Dr. Wu.

Personally, in addition to my Ventolin, I almost always carry my asthma medication card in my wallet/purse [anyone can order a card from the Asthma UK website, here] which, gives details on all of my asthma medications. This including the name of my medications, the dosage, how much I take, when I take it and there is also a column for extra information… For example, since I have been prescribed both the 125/5 and 50/5 doses of Flutiform, I have written that I would take the 125/5 if I am yellow zoning, and I have written these zones in too. This means that although I know what medication I take, by name, if I was ever in a situation that meant that I could not talk then health care professionals do not need to mess about trying to find what medications I am on. This also helps when I see my GP or asthma nurse because we are able to discuss medications in full rather than getting confused with all the different colours…

[Note: I do admit to using the colours to identify inhalers in some situations but this is purely to help people understand which inhalers I am talking about, and I would not do this unless I thought necessary to aid understanding]

You know it’s going to be a bad day when…

… I woke up this morning and I knew straight away that today was going to be tough.

There were quite a few reasons for this the first of which was that I had been up every few hours last night with my lungs complaining. At 3am I decided that I’d give up and just sit up and try and get more comfortable, eventually I fell back to sleep inhaler in hand. But it doesn’t help when my sleep pattern is all over the place and I have to be up early for x-rays (in today’s case) and college on normal days. I was so tired today that I nearly fell asleep twice (not a good luck, and the teachers were not too pleased).

The second reason why today wasn’t good was that my wrists and one elbow are flaring. When I woke up it took me about 5 minutes just to stretch my arms nought to make them fairly straight because they were so stiff and sore. Thing is my elbows flaring is a sign of a big flare which I’m not too happy about but that’s just life, we each have our own challenges.

The third reason that today wasn’t going to be a good day was that when I woke up my best peak flow was only 240! That’s not good for me being about 60% on my new plan and only 53% on my old plan and I seriously felt as bad as my peak flow was. I checked it again about 10 minutes ago and it’s the same. It does explain why I was having a really hard time going up stairs at college but I have been much worse so its a case of monitoring it and going to the doctors if I get much worse. I guess it didn’t help that I lowered my dose of symbicort today, but I’ll just up my ventolin and see what happens.

The fourth reason is that I had to get up early for my x-ray which took less that five minutes which has made me even more tired. Oh and in my rush to get to the x-ray department I forgot my homework so had to go back for it.

And my last reason why today wasn’t a good day is that my morning stiffness has not worn off yet, my wrists and elbow are still really stiff and sore. And what’s quite strange is that my joint in the right hand side of my body are flaring a lot more than the left side. Just a case of sucking up to it.

Anyway today wasn’t one of my best days but I’m hoping tomorrow will be better and I’m sure it will come with new challenges and experiences for me.

Okay so everyone with asthma will know what a trigger is. For anyone who doesn’t know it is anything that causes a person’s asthma to get worse usually to the point where they have an actual asthma attack, unless the trigger is removed.

Everyone’s triggers are different, what is bad for one person might be fine for another person.

I am quite lucky in that I don’t have many triggers, and in the fact that only two of my triggers are because of allergies. Many people find that they are allergic to their triggers and so by avoiding the allergen can reduce the attacks from said trigger.

My two triggers that I am allergic to are:

  • Dust – most people are allergic to this
  • Chlorine, this tends to be in swimming pools that have a high chlorine content which is pretty much every pool round where I live.

Okay so the dust trigger, that doesn’t bother me too much, I get a little wheezy, take my inhaler and bang! I can breathe freely again. I do try to limit contact with dust, damp cleaning any surfaces in my room regularly. Even the simple things can make a difference to one’s asthma.

As for chlorine, I haven’t made a huge effort to avoid it, since I work at swimming pools 4 times a week it is quite hard to avoid. Thing is that chlorine is such a huge trigger for me that I’m wheezing within 10 minutes of coming into contact with it even with pre-medicating. If I am at a pool for an hour it is not uncommon for me to use my inhaler 4 or 5 times, each time relief only lasts about 10 minutes so I know I will have to do something about this.

Okay so my other triggers are quite hard to avoid:

Humidity – you just have to try and stay inside for this one

Thunderstorms – I think this has something to do with the pressure changes but don’t quote me on that one 🙂

Colds/illness – well quite a lot of people with asthma have this as a trigger and I guess the best thing you can do is just try and fight it off best you can

Cold air – I’m not quite sure if this is one of my triggers, sometimes I’m fine in the cold and sometimes I am not, I’ve been skiing and been perfectly fine then come home and at 5 decrees Celsius the air temperature has set my asthma off

Exercise – exercise is a definite for me, at first everyone thought I had EIA so either way exercise is my trigger. For some though EIA can be a symptom that your asthma isn’t controlled so watch out for it

Paint fumes – my lungs hate it when we are redecorating the house, I end up leaving every window wide open for days after painting, gloss paints happen to be the worst for me :\

Confessions of a bad asthmatic

Okay so I know that preventer medication is really important if you are asthmatic, it can make the difference between if you will have an attack or not and the severity of your attack.

So I have a confession to make. I’ve been a bad asthmatic. I finished my serevent (LABA) two weeks ago and haven’t refilled my prescription – oops. I am trying to step down but it really isn’t working so I do need my serevent but I can’t get out of college to do it. TOO MUCH WORK! (That’s my excuse but I really do need to be more proactive about these things). The good thing is that I have an appointment with my asthma nurse on the 30th so I only have to wait a few more days.

Oh and then there is another thing that I am going to confess to in advance – my inhaled steroid is going to run out on the 25th – oh oh, that means I have a serious problem on my hands, I’m going for 5 days without any kind of controller or preventative medications and it’s my own fault. So when I do go and see the asthma nurse I already know what kind of lecture I am going to get, and I’m not looking forward to it.

On other news though I am hoping to either start a trial of symbicort or seretide (advair) but I will have to see what the asthma nurse says about that.