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fostair vs seretide in copd
nursejackie

50 Posts

Posted:  02-Oct-2015 15:19
I read and heard that fostair can be good in helping copd patients, I have a patient on 500 seretide and tiotoprium, but I am concerend that is I switch him to fostair the beclamethasone in fostair in less potent than the fluticasone in seretide.

any experience of this anyone ?

I am stuggling with all the different doses 100/6 mcg of this and that! is there any books that people use I do have the mims.

thanks
jx
pymouth1

861 Posts



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Posted:  02-Oct-2015 18:19
What about switch to flutiform if its the cost issue that is making your patient need to switch seretide as both have fluticasone? But you may find your patient is just as good without high dose steroid? and less side effects? 

Judy
nursejackie

50 Posts

Posted:  05-Oct-2015 10:58
Thanks, Judy, it is not really cost more to help patient with symptoms.

Thanks Castles,

Thanks for useful link will have a look, what I am confused about is if I switch him from seretide 500 to Fosatair 2p bd it will be less potent thatn seretide dose currently on?

thanks
Jx
nursepippa

125 Posts

Posted:  05-Oct-2015 13:49 Log in to like this post
We are moving all our seretide 500 patients to fostair (2 puffs bd with aerochamber)or symbicort 400/12, due to the incresed risks of pneumonia with high dose steroids. Seretide 500 one bd is equiv to 2mg pred a day.Research shows they really dont need to be on steroids at all unless there is an asthma element to their disease or they are exacerbating frequently.
I spoke to the resp consultant and many patients are being taken off inhaled steroids inless they have the above and put on LAMA/LABA combinations.

nursejackie

50 Posts

Posted:  05-Oct-2015 13:57
thanks,

He does exacerbate frequently so perhaps not the best patient to change, I was only changing to try and help his symptoms rather than cost.
thanks
JX
pymouth1

861 Posts



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Posted:  05-Oct-2015 17:02
Oops about the fact the flutiform doesn't have a licence in COPD! Thanks castles!

I think COPD can be tricky for us as we want to help patients feel better but it is a progressive disease in which inhalers are of limited value, and switching the combination inhaler to another combination inhaler isn't likely to make much, if any, difference. (in my opinion!) On the other hand Pulmonary rehab is worth considering if he hasn't already done it. 

Wasn't there a thread on here recently about this subject? along with suggestions about O2 check if sats low and referral to community team? 

Judy
healpro

599 Posts



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Posted:  05-Oct-2015 20:07
I would disagree that inhalers have a limited function in COPD. They help prevent exacerbation, provide symptomatic relief and have a valuable role in preserving lung function.
I would also disagree that it is not worth swapping combination inhalers. As has been discussed above, it id definitely worth changing seretide patients to lower dose steroid combination inhalers to reduce steroid load and reduce risk of pneumonia.
I have also changed LAMAs on patients with triple therapy with very good effect in terms of SOB relief.
It is always worth reviewing meds in COPD patients
pymouth1

861 Posts



Profile Picture
Posted:  07-Oct-2015 18:07
I took a look at our Meds management  CCG recommended guidance for COPD in the form of a flo chart and it does mention flutiform as 2nd line, as an acceptable subsitute for seretide (even though un licenced in COPD). 
Agree its worth considering reducing the steroid load if  patient is on seretide 500 bd and heartening to know that you find changing inhaler brands can make a difference. 

Judy
Prissy

164 Posts

Posted:  07-Oct-2015 19:51
DuoResp Spiromax is now our first line dry powder for COPD and Asthma.
nursenancy

84 Posts

Posted:  30-Jan-2016 20:07
I think that this thread shows how confusing the.guidelines are. Agree with above about Seretide being less favourable for COPD. LABA/LAMA is definitely the way forward. Fostair is a good choice DuoResp is like symbicort but cheaper and is also a good alternative 

i think LABA and LAMA definitely first choice

Thoughts ?
woody2296

2 Posts

Posted:  22-Feb-2016 08:01
No one has mentioned inhaler technique (as far as I can see?!) This has to be a major consideration! If a COPD patient does not have the inspiration flow necessary to trigger a dry powder device, it is irrelevant which drug is used, it will be ineffective! As a respiratory nurse for a good number of years, I was so relieved when Fostair became licenced! I saw miraculous improvement in some patients who were responsive to the steroid component!

In short, like with a lot of these drugs, there is no direct numerical comparison. The Beclometasone in Fostair is different to that in say Clenil; described as 'small particle'. This, used with an appropriate spacer device, can improve deposition immensely.

Other things I would consider: Is it worth swapping the LAMA too if inspiration flow compromised? Is steroid required/effective or would LAMA/LABA be just as helpful? Often scared to step-down COPD patients, but important to not unnecessarily increase their potential side effect profile ;)

Hope some of this has helped a little
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