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Coughing, wheezing, taking Flovent. Now prescribed Dulera. Would it be reasonable to try Qvar first? Do not want to take Dulera

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I am 49 years old. I have never had allergies or asthma, but now I have been coughing and wheezing for months. I have been taking Flovent twice daily, but have needed my rescue inhaler everyday lately. (More at night.) I have Qvar that I have never used. (An urgent care doctor gave me Flovent first and then my primary gave me Qvar. I just kept using Flovent and never opened the Qvar.) I had a horrible attack last night...the rescue had to be used twice to stop the wheezing. My doctor called today and is putting me on Dulera and XXXXXXX I will be honest-what I have read about Dulera scares me and I really don't want to take it. Would it be reasonable to try the Qvar for a week or so first, or would it not work since the Flovent didn't? Could a new case of asthma be brought on by these high pollen levels? (Meaning it might go away when the pollen levels do?)
Thank you!
XXXXXXX
Posted Wed, 6 Jun 2012 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
Thanks for posting the query on XXXXXXX

After going through your query, I would like to comment the following:

1. You seem to be suffering from allergic rhino sinusitis with hyperreactive airways of which bronchial asthma is one of the causes.

2. You need to visit a Pulmonologist to get yourself evaluated in detail.

3. First of all you need to get investigated in detail viz. Chest xray, allergy testing, serum IgE levels & Pulmonary function test. CT scan thorax if required.

4. After confirmation of diagnosis the treatment can be tailored accordingly.

5. Coming to your treatment, considering a diagnosis of hyperresponsive airways with allergic rhinitis (?UACS- upper airway cough syndrome).
a. You are currently taking flovent (Fluticasone) and Qvar (beclomethasone).
Both are most of the times not recommended as monotherapy.If you have wheezing episodes a bronchodilator needed to be added in inhaled as well as oral form. Never should both of them be taken at the same time or together in any form.
b. Now a days SMART (Single maintenance and reliever therapy is prescribed) i.e. single inhaler can be used as maintenance and reliever therapy.
c. Dulera (formoterol/ mometasone) is definitely a better option then the previous one.
d. Also oral add on brochodilators along with tablet montelukast may be required in your case.
e. Based on allergy testing allergen immunotherapy might again be an option. For this an allergy specialist needs to be visited.
f. A new onset asthma at your age is not normally expected but it is a possibility. Do you have any history of childhood respiratory infections?
g. Rhinitis if present will respond to nasal spray of fluticasone.
h. If you have increased purulence of sputum or presence of fever, then a short course of antibiotics may be required.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
Follow-up: Coughing, wheezing, taking Flovent. Now prescribed Dulera. Would it be reasonable to try Qvar first? Do not want to take Dulera 4 hours later
Hi,

I am on an antibiotic (Augmentin 500-125 MG). I am also taking Fluticasone nasal spray twice daily. I had a chest x-ray, which was clear.

I am sorry if my question was confusing. I have only been taking Flovent morning and night as a preventative. I just stopped taking Flovent and started on Qvar. My question is, should I give Qvar a try for a few weeks? It it better than Flovent? (My doctor wrote me a prescription for Dulera and Singular.) I am really afraid of Dulera. The side effects sound quite scary. I am taking Xopenex as needed for rescue.

Thank you,

XXXXXXX
 
 
Answered by Dr. Gyanshankar Mishra 17 hours later
Hi,
Thanks for the follow up.
After going through the followup query, I would like to comment the following:
1. Qvar is an older molecule then flovent and hence no significant advantage over flovent.

2. I would rate dulera ahead of any of these as far as efficacy is concerned. The side effects of inhaled therapy is minimum. Remember the doses is in micrograms and the oral drugs come in miligrams! Only thing is proper technique and never forget to rinse mouth with water after using inhalers.

3. If formoterol budesonide combination is available, that would be more better then dulera also and can be used as single inhaler both for maintenance and rescue!

4.Xopenex is acceptable as rescue medication.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
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