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Is Foracort effective at treating Asthma while on Budesonide?

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Posted on Sat, 15 Feb 2020
Question:
Hi, I had asked you a question on my brother Asthma condition from childhood and stopping the Foracort 200 which he is taking everyday 2 puff at night.

You suggested taking budesonide 200 twice daily and gradually reducing the dose to see if he can completely get rid of these medications.

I got him the budesonide and after taking it he was complaining about uncomfortableness while sleeping at night and stopped taking it and went back to Foracort 200 everyday 2 puff at night.

Later you suggested to take a PFT and attached is the report and request you to go through it and suggest on how we can plan his treatment.

He is 30 year old now and otherwise a healthy person. Please let me know in case you need further details. Report is attached.
doctor
Answered by Dr. Kaushal Bhavsar (11 hours later)
Brief Answer:

Give him foracort 200 one puff twice daily.

Detailed Answer:

Hello,

Sorry for late reply as I was busy.
I have gone through the PFT report you have attached.
In my opinion, he should take foracort 200 1 puff twice daily.
Foracort is having formoterol and budesonide. Both are having a half-life of 10-12 hours. So twice daily dose is required.
Along with foracort, a combination of montelukast and fexofenadine at bedtime will also help him.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Kaushal Bhavsar, Pulmonologist
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Kaushal Bhavsar (32 minutes later)
Thanks for the reply.

As you understand the whole intention here is to see if he can completely get rid of these inhalers.

I request you to let me know the plan to see if we can achieve it in next 1 to 2 years.
Are you suggesting to change the dosage of Foracart 200 1 puff twice a day along with the tablet you suggested as a plan towards achieving it?

Also, in the report it is mentioned as COPD Severity is Restrictive. What exactly is this? Does the report shows evidence of Asthama? Please suggest.
doctor
Answered by Dr. Kaushal Bhavsar (8 hours later)
Brief Answer:

Get done reversibility testing.

Detailed Answer:

Hello,

His PFT report is suggestive of restrictive pattern.
This is because of asthma.

Asthma causes bronchospasm. This spasmodic restrict lungs to expand and gives restrictive pattern on PFT.

Ideally in asthma, PFT with reversibility should be done.
In this, first PFT is done. Values are recorded.

Then another PFT is done after taking inhaled bronchodilators (Salbutamol or levosalbutamol).

If values are increased after inhaled bronchodilators by 20% then it is said to be reversible asthma.

And this is having good outcomes.
So get done reversibility testing.

His plan would be like this:

1. Continue with foracort 200 1 puff twice a day. Montelukast and fexofenadine combination at night. For 1 month.

2. Continue with foracort and change to montelukast 10mg once a day at night for 1 month.

3. Continue with foracort and change to montelukast 5 mg for 1 month.

4. If all goes well then continue with foracort 100 twice daily along with montelukast 5 mg for next 3 months.

5. Then step down to budesonide (budecort) 200 twice daily for 3 months.

6. Then budesonide 100 twice a daily for 3 months.

7. Then budesonide 100 once a day for 3 months.

8. Then budesonide 100 as and when required.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Kaushal Bhavsar, Pulmonologist
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Kaushal Bhavsar (38 minutes later)
Thanks for taking out time for the detailed answer.

I will get the PFT with reversibility test done asap and send you the report.

Also, montelukast is a tablet name or a component in the tablet?

Can you please let me know tablet name and mg for "Montelukast and fexofenadine combination at night. For 1 month."
doctor
Answered by Dr. Kaushal Bhavsar (1 hour later)
Brief Answer:

What is his weight?

Detailed Answer:

Hello,

I will wait for PFT report. I forgot to ask you his weight.
What is his weight? Dose of montelukast and fexofenadine combination depends on the weight of patient.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Kaushal Bhavsar, Pulmonologist
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar (1 hour later)
Hi weight is 66kgs and height is 172 cm. This is mentioned in the report also.

As we wait for the report of reversibility testing, I just wanted to check FEV1/FVC% which is mentioned as > 70 and I think it is expected ratio in a healthy person. Where as FVC% should be more than 80% but it is less in his case. I am asking this just to see if the test is done properly as I believe this test completely relay on how the patient perform it. I checked with him on the test and he says it was done successfully.
doctor
Answered by Dr. Kaushal Bhavsar (32 minutes later)
Brief Answer:

His FVC is low that's why the ratio is high.

Detailed Answer:

Hello,

Yes, your understanding is right. His graph is up to the mark without any artifacts so his effort is good. His FVC is low so his ratio (FEV1/FVC) is high.

He'd be needing prescription based medications i.e. Montelukast (10mg) and Fexofenadine (180mg) combination (eg. Montair FX, Odimont FX, Allegra M).

I will wait for PFT with reversibility report.
I will be happy to help you further.

Hope I have answered your query.

Take care

Regards,
Dr Kaushal Bhavsar, Pulmonologist
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Kaushal Bhavsar

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Is Foracort effective at treating Asthma while on Budesonide?

Brief Answer: Give him foracort 200 one puff twice daily. Detailed Answer: Hello, Sorry for late reply as I was busy. I have gone through the PFT report you have attached. In my opinion, he should take foracort 200 1 puff twice daily. Foracort is having formoterol and budesonide. Both are having a half-life of 10-12 hours. So twice daily dose is required. Along with foracort, a combination of montelukast and fexofenadine at bedtime will also help him. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr Kaushal Bhavsar, Pulmonologist