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Have asthma, diagnosed with CAD, DM II & HTN , underwent angioplasty. Take foracort or seroflo?

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Hello Doctor! I am 60 and a profesor in an engineering college. I was diagnosied with asthma long back and was on serflo 250 inhaler2 puffs BD throughout the year for last 10 years and was so much under control that i almost got no symptoms anytime ever.Meanwhile, i was again diagnoised with CAD, DM II & HTN (now under control) and underwent an angioplasty with 2 stents in 2009 and was continuing rechecked fewmonths back.However, this season change here in Nov, I again had cough, cold and the asthma increased to a level where I was admitted to a hospital and the specialist changed the inhaler to Foracort 200 after regular mangement with injectable & oral stereoids, unicontin ER 400 OD, Montair 10 OD plus my usual medicines for about a week. He and another doctor have a strong opinion in favour of Foracort. But it is clearly not giving much relief. So I tried Seroflo again on my own and since last 3 days, I am better. I cannot confront them. What should I do?
Posted Thu, 26 Apr 2012 in Asthma and Allergy
Answered by Dr. Gyanshankar Mishra 3 hours later

Welcome to XXXXXXX

From your history, I understand that you are a diagnosed case of Bronchial Asthma since last 10 years on seroflo 250 inhaler 2 puff bd on which you were symptomatically controlled. You were later diagnosed with CAD, DM2 & HTN and took treatment for the same. This Nov. you seem to have an episode of Asthma exacerbation for which you were hospitalised. This time you were started by Pulmonologist on Foracort 200 inhaler , oral steroids , unicontin er 400 od , montair 10 od. You tried seroflo for 3 days and felt better.

Based on you history I have the following to comment:

1. As regards your symptomatic improvement with seroflo 250 , I would like to say that Foracort has the advantage over seroflo in that foracort can be used as SMART (Single Maintenance & Reliever Therapy) - i.e. you can use the same inhaler as maintenance as well as reliever inhaler (as and when required in addition to bd dosing). Also I am supposing that you were on foracort 200 2 puff bd and as and when required. If not controlled then you could increase the dose to 4 puff bd with the consent of your physician.

2. Have you recently measured your pulmonary function test(PFT) / PEFR reading? If yes then have they improved over previous readings?

3. You can consult your Physician regarding change of inhaler if inspite of Foracort 200 4 puff bd & as & when required , you are not feeling symptomatically relieved.

4. There is another option of FORMOFLO - 250 (Formoterol + Fluticasone) inhaler which is very much like seroflo (Salmeterol + Fluticasone ). The only difference being that formoflo contains formoterol instead of salmeterol & formoterol is a better molecule compared to salmeterol. Also Formoflo 250 can be used as SMART therapy.

5. Switching back to your old therapy(seroflo 250 2 puff bd) is also an option but you need to take another reliever inhaler like asthalin (salbutamol) as and when required since you cannot use seroflo in emergency. Seroflo takes some time to start its action.

6. You should openly discuss this with your physicians and get your PFT / PEFR measurements done so as to see if you are improving or not with your inhalers.

7. Also Doxophylline seems to be a better option than unicontin er (Theophylline 400 mg) od in your case considering you are suffering from CAD with Hypertension and hence cardiac safety profile needs to be discussed.

8. Considering your age and comorbidities I would advise you to get Annual Influenza vaccination and 5 yearly pneumococcal vaccinations regularly. You can also discuss this issue with your Physician.

Hope I have answered your queries. Please do let me know If you have any further queries.

Wish you good health.

Take care.

Dr. Gyanshankar Mishra
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