Steroid Inhalers for COPD

[Neeranam]

I was diagnosed with Asthma and Emphysema however don't believe the doctor, long story. 

I was put on 50/500 Seretide inhaler which fixed the issue of breathing, after getting Covid. 

Moved to 50/250 Seretide, then to 25/125, which I'm currently taking. 

Can anyone recommend what to do next in my taper? I can't find the Seretide 50 anywhere in Thailand. 

Maybe an equivalent brand?

Edited July 28, 2023 by Neeranam

[stubuzz]

39 minutes ago, Neeranam said:

Can anyone recommend what to do next in my taper?

Every second day.(48 hours)

[Neeranam]

2 minutes ago, stubuzz said:

Every second day.(48 hours)

Thanks, that is an option. 

However, I believe the medicine only lasts for 12 hours?

[stubuzz]

43 minutes ago, Neeranam said:

Maybe an equivalent brand?

You can buy Budesonide: another steroid inhaler.

[Sheryl]

25/50 does exist. Have you tried asking Medisafe? https://medisafepharma.com/

(use the Messenger function)

 

If that fails then you could try a switch to just a fluticasone inhaler.  What you currently take is 25mcg salmeterol (a bronchodilator) and 125 mg of fluticasone (a steroid).  25mcg is already a minimal dose of salmeterol and next step would either be to stay on that low dose or discontinue it. But there is room for more "weaning" on the steroid.

 

Avamys inhaler has 27.5 mcg of fluticasone in each puff, so 2 squirts would be 55 mcg. Alternatively, Fliuxonase inhaler has 50 mcg per puff. 

[Poseidon]

"however don't believe the doctor," simple solution you need a lung function test and a CT scan. You will soon know if there was a mistake with the diagnosis 

[Kwaibill]

For what it’s worth I was diagnosed with asthma and COPD. Gave me lots of trouble when living at 2,000 meters elevation in AZ… C pap, inhalers, supplemental oxy, the whole program.  Since moving to near sea level here in Thailand very little trouble. I do still have a couple of inhalers for “emergencies” but those are pretty rare ( not sure what the “trigger” is; darn sure not running anymore!????)

I have found that caffeine from a cup of coffee, e.g. can “tide me over”. A couple of times when in hospital my O2 saturation was low( under 90%) and they put me on oxygen and at 2 liters.

Stop smoking in 2010 sure helped.

Don’t know if any of this helps; YMMV.

[nglodnig]

On 7/28/2023 at 7:16 AM, Neeranam said:

I was put on 50/500 Seretide inhaler which fixed the issue of breathing, after getting Covid. 

I used beclamethasone until my (turns out to be kook) doctor put me on Seretide. Enormous weight gain followed - coincidence? 

 

I went back to the beclamethasone one. It was also used as "cure"/prevention for Covid I seem to recall.

[Neeranam]

17 hours ago, Sheryl said:

25/50 does exist. Have you tried asking Medisafe? https://medisafepharma.com/

(use the Messenger function)

 

If that fails then you could try a switch to just a fluticasone inhaler.  What you currently take is 25mcg salmeterol (a bronchodilator) and 125 mg of fluticasone (a steroid).  25mcg is already a minimal dose of salmeterol and next step would either be to stay on that low dose or discontinue it. But there is room for more "weaning" on the steroid.

 

Avamys inhaler has 27.5 mcg of fluticasone in each puff, so 2 squirts would be 55 mcg. Alternatively, Fliuxonase inhaler has 50 mcg per puff. 

Thanks Sheryl, very helpful. 

[Neeranam]

8 hours ago, Kwaibill said:

For what it’s worth I was diagnosed with asthma and COPD. Gave me lots of trouble when living at 2,000 meters elevation in AZ… C pap, inhalers, supplemental oxy, the whole program.  Since moving to near sea level here in Thailand very little trouble. I do still have a couple of inhalers for “emergencies” but those are pretty rare ( not sure what the “trigger” is; darn sure not running anymore!????)

I have found that caffeine from a cup of coffee, e.g. can “tide me over”. A couple of times when in hospital my O2 saturation was low( under 90%) and they put me on oxygen and at 2 liters.

Stop smoking in 2010 sure helped.

Don’t know if any of this helps; YMMV.

Thanks. Actually, I started running 5km everyday when put on the seretide, I think it helps. 

[Neeranam]

17 hours ago, Sheryl said:

25/50 does exist. Have you tried asking Medisafe? https://medisafepharma.com/

(use the Messenger function)

They only have symbicort 160/4.5, maybe that will do. I'm trying to find an equivalence table. 

 

So I can just stop talking the salmetetol, that's good to know, thanks. 

[Sheryl]

6 hours ago, Neeranam said:

They only have symbicort 160/4.5, maybe that will do. I'm trying to find an equivalence table. 

 

So I can just stop talking the salmetetol, that's good to know, thanks. 

You can TRY just stopping the salmeterol. No guarantee it will work.

 

Rather than switch to different drugs which may muddy the waters I suggest you try to find fluticasone inhaler.  Start with 100mcg of that (close to current dose) so you can see the effect (if any)  of having stopped the salmeterol. If none then wean down the steroid dose gradually. 

[Neeranam]

4 hours ago, Sheryl said:

You can TRY just stopping the salmeterol. No guarantee it will work.

 

Rather than switch to different drugs which may muddy the waters I suggest you try to find fluticasone inhaler.  Start with 100mcg of that (clise to current fose) so you can see the effect (if any)  of having stopped the salmeterol. If none then wean down the steroid fose gradually. 

OK thanks again. 

[Paris333]

You can take vitamin benfotiamine liposomal for immediate absorption to clean your breathing system.(£12 from England) but you can estimate delivery cost or customs to Thailand.This is vitamin liposomal and not drug .Drugs are inhibitions of the disease but do not cure it.

 

[Neeranam]

On 7/29/2023 at 1:23 AM, Sheryl said:

Avamys inhaler has 27.5 mcg of fluticasone in each puff, so 2 squirts would be 55 mcg. Alternatively, Fliuxonase inhaler has 50 mcg per puff. 

Hi Sheryl. 

All I can find with this is a nasal spray, is that what you mean, can this be for asthma? 

[Sheryl]

2 hours ago, Neeranam said:

Hi Sheryl. 

All I can find with this is a nasal spray, is that what you mean, can this be for asthma? 

No, nasal spray would not be for asthma. And you are right, only nasal preparations available, my error.

 

Could try a different steroid e.g. beclometasone  which comes in brand name Clenil. The dosage equivalence is 2:1 i.e. 100mcg beclometasone is equiavelent to 50 mcg of fluticasone so would need 2 puffs of Clenil 50. (Make sure it is Clenil 50 not Clenil 250.)

 

OR

 

Foster inhaler which is beclometasone 100 + formoterol 6, roughly equivalent to  fluticasone 50 and salmeterol 12.

 

Symbicort 160/4.5 which you indicated you could find is last resort as it is equiavelent to  fluticasone 80 and salmeterol 9.

 

 

[Neeranam]

11 hours ago, Sheryl said:

No, nasal spray would not be for asthma. And you are right, only nasal preparations available, my error.

 

Could try a different steroid e.g. beclometasone  which comes in brand name Clenil. The dosage equivalence is 2:1 i.e. 100mcg beclometasone is equiavelent to 50 mcg of fluticasone so would need 2 puffs of Clenil 50. (Make sure it is Clenil 50 not Clenil 250.)

 

OR

 

Foster inhaler which is beclometasone 100 + formoterol 6, roughly equivalent to  fluticasone 50 and salmeterol 12.

 

Symbicort 160/4.5 which you indicated you could find is last resort as it is equiavelent to  fluticasone 80 and salmeterol 9.

 

 

Thanks, that's helpful. 

[2baht]

I take Spiolto Respimat

[Poseidon]

https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ we all are tought to use these as our guidelines to manage COPD. It Will cover everything in depth. But I'm adamant, if you think you have been misdiagnosed,only a lung function test with reversibility testing. and a CT if you can afford it is the only way to know for sure how your lungs are.

 

[Poseidon]

Zephyr valves can help relieve symptoms as well.

[Huayrat]

On 7/28/2023 at 1:00 PM, stubuzz said:

You can buy Budesonide: another steroid inhaler.

Where can you Buy a Budesonide inhaler from? I thought it was prescribed only.

[Neeranam]

On 8/2/2023 at 4:49 AM, Poseidon said:

https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ we all are tought to use these as our guidelines to manage COPD. It Will cover everything in depth. But I'm adamant, if you think you have been misdiagnosed,only a lung function test with reversibility testing. and a CT if you can afford it is the only way to know for sure how your lungs are.

 

Thank you, very useful.

I was told I have to go to Bangkok to check if it asthma or COPD. 

One friends thinks it spike protein from getting a vaccine.

[Neeranam]

On 9/21/2023 at 5:57 PM, Huayrat said:

Where can you Buy a Budesonide inhaler from? I thought it was prescribed only.

I get Seretide over the counter, and online so imagine the others are similar.