Dual Inhaled-Steroid Madness - Asthma.net

“So, I have a note here,” the pharmacy assistant says, unclipping a blue paper from the highest of the folded paper pharmacy bag, and continuing to achieve in. He extracts the Zenhale (Dulera) and Qvar, “that-”“Yes,” I interrupt, considerably laughing and as well mannered as I can probably interject and save him a while, “Those both contain an inhaled steroid. I’m aware.”“Okay, good! Someone flagged this so I just had to make sure!”“No problem,” I instructed him as he changed the boxed inhalers again within the bag. “It seems to pop up or get flagged in the system every year or two.”“Often one of our pharmacists will just notice it because of the overlap, and then they’ll make a note of it.”I chuckle, “Yep, been there before, I’ve been on this combo for probably 5 years now.”
He scans the labels on the bag, prints, and staples the receipt to the re-folded over high. “I’ll put a note in your file, hopefully, that’ll help!”The pharmacy assistant fingers me my bag, and I head out of the pharmacy considering a) why did they not simply make an observation earlier than? and b) I form of want I’d gotten the opposite pharmacy assistant, not as a result of the dude wasn’t good, however as a result of she all the time asks when I’m going to California subsequent, and I had information to inform her that I could also be getting into Might. Alas, I must wait till I’m going for Nasonex I suppose!
Ah sure… one other steroid.
Twin-inhaled steroids: What offers?
My dual-inhaled corticosteroid journey began once I was on a ridiculous 9 puffs of Symbicort a day. Sure, that’s technically over what they’re presupposed to prescribe. My then-allergist and I labored to lower my Symbicort by including Pulmicort, the speculation being I wanted extra inhaled steroid for the irritation, however not as a lot lengthy performing bronchodilator as I used to be getting-which was, certainly, rather a lot.
Simply earlier than I switched to my present respirologist, AKA Dr. Smartypants, I swapped Pulmi for Qvar, after which when it turned accessible in 2011, Symbicort for Dulera. 1 This has been my greatest mixture, and I’ve since been in a position to lower my Zenhale additional, probably as a result of smaller particle measurement of Qvar moving into my tinier airways 2-hooray!
Typically, sufferers reply higher to at least one steroid over one other. In my case, budesonide (in Pulmicort/Symbicort) doesn’t work as nicely for me as Qvar (beclometasone) does in tandem with Symbicort, and equally, Qvar in tandem with mometasone (in Zenhale). It’s a bizarre world of trial and error, and it ought to go with out saying that your expertise might differ! For me, I feel the smaller particle measurement of Qvar would possibly matter.I’m additionally, due to the add-on steroid in fact, on a decrease quantity of lengthy performing bronchodilator (LABA)-which is sweet given I already take a stimulant med for ADHD, and I actually don’t need an excessive amount of extra heart-rate rising LABA on board. Luckily, the additional steroids appear to do me nicely!
Lowering the inhaled steroids: Extra trial and error
Dr. Smartypants and I revisit the dialogue of reducing my inhaled steroids and my ICS recurrently. Each Spring/Summer season I try to lower my meds, with just a few intermittent will increase when wanted, and each Winter, my lungs begin sucking extra once more and because the temperatures lower, my meds have to extend. As I’m ready, I always play with titrating my very own doses-as advisable by my doctors-while making an attempt to maintain issues decently in management on the similar time. Discovering the optimum dose is difficult, however having a very good physician helps!
Now, hopefully, my pharmacists aren’t once more confused by my path to optimum dosing… at the very least maybe not for the following yr or so!


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