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Medical Forum / Diseases and Disorders / Asthma / March 2008What happened to everyone?
I'm offline for a few months, and the newsgroup dries up and blows away.. Did everyone leave? I wanted to ask about advair and qvar, used to take both and my pharmacist questioned the wisdom of that at the time. It did make the asthma almost entirely vanish! But just the advair by itself has been enough for a long time now, until recently. I suspect my doctor will want me to get back on the qvar, hence why I was wondering if anyone else had been on both at the same time. Dragonfly > I'm offline for a few months, and the newsgroup dries up and blows > away.. Did everyone leave? [quoted text clipped - 7 lines] > > Dragonfly I still check in regularly but don't post often. It is not totally insane but I would question it as well for most people. Qvar is an inhaled steroid while Advair is the combination of an inhaled steroid and a long acting dilator. Advair is cheaper than buying the components seperately. Some people think that Qvar has better lung deposition but if this is the case why not just use the Qvar at whatever dose is required and give you a seperate Serevent inhaler (or Foradil)? If he likes the steroid in Advair (flucasone) why not just increase the dose of Advair to the 500/50 inhaler and if he still wants to add steroid to that give an additional Flovent inhaler(also fluticasone)? The manufacturer says you are not supposed to use the Advair more than 60 days after removing it from the foil pouch (although I do it all the time) so there is some argument to adding and subtracting a steroid inhaler to a mid dose of Advair (like 250/50) if the increase is going to be for less than a month (rather than throwing out a perfectly good Advair inhaler). The other thing is that Qvar is a little cheaper than Flovent so it would be a cheaper addition. However, it would be cheapest to just go up to the 500/50 Advair if you are not taking it already. If you are it would be cheaper to take Serevent and high dose Qvar so I'm thinking the cost is not really the issue. It would be interesting to know what your doctor says.  Signature00doc > I still check in regularly but don't post often. > [quoted text clipped - 8 lines] > Advair to the 500/50 inhaler and if he still wants to add steroid to that > give an additional Flovent inhaler(also fluticasone)? I was first started on the 500/50 advair, though at the time I was prescribed the qvar three times a day and the advair only twice. I hadn't thought of that til now actually, which makes me wonder if I just add the afternoon dose of qvar if the breathing troubles would go away again... *makes a note of it for next MD appointment* > The manufacturer says you are not supposed to use the Advair more than 60 > days after removing it from the foil pouch (although I do it all the time) > so there is some argument to adding and subtracting a steroid inhaler to a > mid dose of Advair (like 250/50) if the increase is going to be for less > than a month (rather than throwing out a perfectly good Advair inhaler). Hrm, the advair I have says to not use after its been opened for 30 days, do you know whether this is because the stuff breaks down over time and would no longer work? Not that my current inhaler's been open any longer, just curious since you mentioned it. > The other thing is that Qvar is a little cheaper than Flovent so it would be > a cheaper addition. However, it would be cheapest to just go up to the > 500/50 Advair if you are not taking it already. If you are it would be > cheaper to take Serevent and high dose Qvar so I'm thinking the cost is not > really the issue. Cost is no issue at the moment, the county health plan I'm on has no co-pay for medications prescribed by doctor that is on the "approved" list, which both qvar and advair are. > It would be interesting to know what your doctor says. Thanks for your insight, I'll try to remember to post here what my doc thinks of all this, when I see her in two months. Thankfully, I've not had any asthma attacks away from home bad enough to make me run to the doctor's just yet. And, at home, I have my wonderful nebulizer. I'm now wondering if it isn't just that missing afternoon dose of inhaler that's causing me problems. It is definitely mid-afternoon and early evenings up to the night dose of advair that I'm having most breathing problems. It was for that exact reason that my doctor originally had the qvar dosage increased to three times a day, way back when before I started taking the advair. But, advair can only be taken twice a day, I was told. Dragonfly On Mar 15, 12:51 pm, "00doc" <00...@comcast.net> wrote: > I still check in regularly but don't post often. > [quoted text clipped - 11 lines] > > that > > give an additional Flovent inhaler(also fluticasone)? > I was first started on the 500/50 advair, though at the time I was > prescribed the qvar three times a day and the advair only twice. I > hadn't thought of that til now actually, which makes me wonder if I > just add the afternoon dose of qvar if the breathing troubles would go > away again... *makes a note of it for next MD appointment* For most people the steroid can be given once or twice daily. It may be that you just need more and could add the extra dose to the morning and/or evening dose. On the other hand you might be unusual and really do better with three doses daily. The only way to know is experiment. > > The manufacturer says you are not supposed to use the Advair more than > > 60 [quoted text clipped - 4 lines] > > mid dose of Advair (like 250/50) if the increase is going to be for less > > than a month (rather than throwing out a perfectly good Advair inhaler). > Hrm, the advair I have says to not use after its been opened for 30 > days, do you know whether this is because the stuff breaks down over > time and would no longer work? Not that my current inhaler's been open > any longer, just curious since you mentioned it. You are right - the package insert says to destroy it one month after opening the foil pouch. As I said I use it intermittently and so sometimes use ones that have been open a year or more. They seem to work just fine but my asthma is currently mild enough that I am not sure I would notice a decrease in effectiveness. Of course, if this is an aisue you could use the MDI (traditional puffer) and presumably not have the same issue. > > The other thing is that Qvar is a little cheaper than Flovent so it > > would be [quoted text clipped - 3 lines] > > not > > really the issue. > Cost is no issue at the moment, the county health plan I'm on has no > co-pay for medications prescribed by doctor that is on the "approved" > list, which both qvar and advair are. That is a large part of the problem with the American healthcare system. People think they are not paying if they do not exchange cash at the register. You are paying for it one way or another - whether it be cash, more taxes, lower wages, or fewer government benefits. It would be cheaper and more flexible to give Serevent and then a Qvar inhaler and adjust the steroid dose as needed. > > It would be interesting to know what your doctor says. > Thanks for your insight, I'll try to remember to post here what my doc > thinks of all this, when I see her in two months. That would be > interesting. There was a study a while back using an inhaler that contained a combination of albuterol and steroid just as needed vs. a traditional regimen. They found better control with lower total steroid doses presumably because the steroids were always titrated to an exact match with the symptoms/albuterol use. Unfortunately, that inhaler is not available but the results could be mimiced. One way would be to give the Advair 500/50 and then every day have you take a number of puffs of Qvar to equal the previous day's albuterol use (divided twice or three times daily). Alternatively, for some people using Symbicort as needed may be reasonable (but completely and totally off label). Symbicort is a different long acting dilator and steroid combination but the dilator has a faster onset that some people think is fast enough to use as a rescue inhaler (but not all people and not the FDA). Of course, if your doc was not willing to go off label like this (s)he would not be giving the Advair/Qvar combo as you are doing. It would probably not be reasonable for people with a history of sudden severe attacks. The dose of long acting dilator might get to be excessive this way (and would often exceed the recommended doses) but another inhaled steroid could be added at that point. I suspect Symbicort may not be on your formulary. It is not listed as much more expensive as Advair but they don't seem to make deals as aggressively as the Advair people do. Other options would be to add Singulair (probably not on formulary - it usually isn't) or Accolate (better chance to be on formulary). Theophylline may also be useful in low doses to keep the dose of steroid down. Short bursts of oral prednisone as needed for flares is also good for some people. If your problems are mostly at night you may want to consider allergies (dust mites?- add nasal steroids?- something else at home?) and reflux as triggers. Signature00doc > I'm offline for a few months, and the newsgroup dries up and blows > away.. Did everyone leave? [quoted text clipped - 7 lines] > > Dragonfly I'm here too...mostly lurking and avoiding some of the trolls. I was on them both for a very short time....Qvar and I don't get along :(...so I can't offer much help. Michael > I'm here too...mostly lurking and avoiding some of the trolls. I was on > them both for a very short time....Qvar and I don't get along :(...so I > can't offer much help. > > Michael How come qvar didn't get along with you? Be interested to know, as it and advair are the only two inhalers (besides albuterol) that I've ever been on... Dragonfly >> I'm here too...mostly lurking and avoiding some of the trolls. I was on >> them both for a very short time....Qvar and I don't get along :(...so I [quoted text clipped - 7 lines] > > Dragonfly I'm not sure whether it was the propellant or some component of the formulation, but the 3rd time I used it, it seemed that I had an adverse reaction... it triggered an attack. As I was only just trying Qvar at that point, we decided not to push our luck and immediately dropped it. I haven't heard of it happening to others, so I think I may just be one of the few that doesn't do well with it. Michael > > How come qvar didn't get along with you? Be interested to know, as it > > and advair are the only two inhalers (besides albuterol) that I've [quoted text clipped - 11 lines] > > Michael Hm, I've heard of one other person who reacted like that to the qvar. She stayed on it anyways, though, and after a week, the reaction disappeared and the qvar helped a lot. Not that I think you should try it again! She ought to have gone to her doctor about that, but didn't.. Dragonfly > I wanted to ask about advair and qvar, used to take both and my > pharmacist questioned the wisdom of that at the time. It did make the > asthma almost entirely vanish! But just the advair by itself has been > enough for a long time now, until recently. I suspect my doctor will > want me to get back on the qvar, hence why I was wondering if anyone > else had been on both at the same time. Many Dr's have moved away from prescribing Advair after some reports of serious side effects. Those reports are debatable but Advairs use seems to have dropped somewhat. My Dr. currently has me on QVar and Spiriva. It helps a little but I really haven't found anything that has a large effect on my asthma. > > I wanted to ask about advair and qvar, used to take both and my > > pharmacist questioned the wisdom of that at the time. It did make the [quoted text clipped - 6 lines] > serious side effects. Those reports are debatable but Advairs use seems > to have dropped somewhat. Do you have any links to those reports? I'd be interested in reading them for myself. Though, I have not had any adverse reactions to the advair at all and it definitely helps a lot more than the qvar ever did. > My Dr. currently has me on QVar and Spiriva. It helps a little but I > really haven't found anything that has a large effect on my asthma. Between the nebulizer and the advair, my asthma is more or less controlled. Though, I use the nebulizer just about every late afternoon, hence why I am thinking of taking the qvar again. Have you asked your doctor to try something else, or look for allergy triggers? I had a lot of trouble when I was just on the qvar, so I went back to my doctor and she got me the advair, which has been doing a lot of good even just by itself.. Dragonfly > Between the nebulizer and the advair, my asthma is more or less > controlled. Though, I use the nebulizer just about every late [quoted text clipped - 3 lines] > went back to my doctor and she got me the advair, which has been doing > a lot of good even just by itself.. I've been battling severe chronic asthma for over since my early 20's. I'm now in my mid 40's. Lung volume has remained at around 40% of expected. I've tried just about any and all inhalers I know about with little effect. Also tried Xolair injections and as well as immune therapy (allergy injections) with no effect. Dr's feel I have multiple problems all contributing to my asthma and its not easy to control all of them at once. I have serious allergy problems as well as some sort of immune system dysfunction the Dr's can't figure out so far. Earlier this week my Dr. switched me off from QVar. Now taking Zyflo, Symbicort and Spiriva.
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