1. < MAC & Bronchiectasis

Spiriva respimat

Posted by lilianna @lilianna, Apr 11 9:13pm

Has anybody used spiriva respimat one puff daily for mild asthma? My pulmonologist switched me to it a month ago when I had problems with symbicort and arnuity ellipta (shaking). Now I experience "heat waves" multiple times a day and also tight chest so I wonder if spiriva could be a problem. If you used/use spiriva, did you have any side effects? Thank you

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lilianna | @lilianna | May 25 2:22pm
In reply to @rstel7272 "At least in my case, 3 years of Symbicort turned into aspergillus as described in this..." + (show)
@rstel7272

At least in my case, 3 years of Symbicort turned into aspergillus as described in this paper ..
https://www.mdpi.com/2309-608X/6/4/346

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Sorry to hear that. How was is dealt? We rea
Ct so differently to all these meds.

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Mentor
Sue, Volunteer Mentor | @sueinmn | May 25 3:02pm
In reply to @liz440 "Also I am pretty sure that it is dangerous to use a laba without a steroid...." + (show)
@liz440

Also I am pretty sure that it is dangerous to use a laba without a steroid. At least I was told that when I lived in Europe. Maybe the thinking is different in the US? I use breo which is a laba and a steroid.

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Hmm, I think I heard something about that, so I did some looking and you are correct. That is why, at least in the US all LABA's have an added steroid. In my case, the Breyna inhaler (generic Symbicort) includes 80 mcg of budosenide and 4.5 mcg of formoterol. Other dosages are available.

LAMA agents do 2 things, relax the airways, and reducing excess mucus production. There have been few objective studies as yet, but additional research may be verified based on this small observational study:
https://pubmed.ncbi.nlm.nih.gov/33569197
Remember, reducing excess mucus production doesn't necessarily mean totally drying it up. There are many people here who would welcome any reduction in the copious amounts of mucus they produce.
Sue

National Jewish Health supports the selective use combination inhalers in the treatment of Bronchiectasis. ( https://www.nationaljewish.org/conditions/bronchiectasis/bronchiectasis-
overview/treatment )

Many organizations here and in Europe are suggesting that empirical studies of all bronchodilator use in Bronchiectasis be researched further, and that use may not be justified unless a person has underlying asthma or obstructed airways.
https://www.archbronconeumol.org/en-dual-broncodilator-triple-therapy-in-articulo-S0300289623002284 (and others.)

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2 replies
liz440 | @liz440 | May 25 3:25pm
In reply to @sueinmn "Hmm, I think I heard something about that, so I did some looking and you are..." + (show)
@sueinmn

Hmm, I think I heard something about that, so I did some looking and you are correct. That is why, at least in the US all LABA's have an added steroid. In my case, the Breyna inhaler (generic Symbicort) includes 80 mcg of budosenide and 4.5 mcg of formoterol. Other dosages are available.

LAMA agents do 2 things, relax the airways, and reducing excess mucus production. There have been few objective studies as yet, but additional research may be verified based on this small observational study:
https://pubmed.ncbi.nlm.nih.gov/33569197
Remember, reducing excess mucus production doesn't necessarily mean totally drying it up. There are many people here who would welcome any reduction in the copious amounts of mucus they produce.
Sue

National Jewish Health supports the selective use combination inhalers in the treatment of Bronchiectasis. ( https://www.nationaljewish.org/conditions/bronchiectasis/bronchiectasis-
overview/treatment )

Many organizations here and in Europe are suggesting that empirical studies of all bronchodilator use in Bronchiectasis be researched further, and that use may not be justified unless a person has underlying asthma or obstructed airways.
https://www.archbronconeumol.org/en-dual-broncodilator-triple-therapy-in-articulo-S0300289623002284 (and others.)

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I have an appt in JUne and I am going to ask for a switch from laba (breo) to lama (the one you are taking - simbacort (sp?) and see if it will help the excess mucus I have. Thanks for that info.

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1 reply
liz440 | @liz440 | May 25 3:32pm
In reply to @sueinmn "Hmm, I think I heard something about that, so I did some looking and you are..." + (show)
@sueinmn

Hmm, I think I heard something about that, so I did some looking and you are correct. That is why, at least in the US all LABA's have an added steroid. In my case, the Breyna inhaler (generic Symbicort) includes 80 mcg of budosenide and 4.5 mcg of formoterol. Other dosages are available.

LAMA agents do 2 things, relax the airways, and reducing excess mucus production. There have been few objective studies as yet, but additional research may be verified based on this small observational study:
https://pubmed.ncbi.nlm.nih.gov/33569197
Remember, reducing excess mucus production doesn't necessarily mean totally drying it up. There are many people here who would welcome any reduction in the copious amounts of mucus they produce.
Sue

National Jewish Health supports the selective use combination inhalers in the treatment of Bronchiectasis. ( https://www.nationaljewish.org/conditions/bronchiectasis/bronchiectasis-
overview/treatment )

Many organizations here and in Europe are suggesting that empirical studies of all bronchodilator use in Bronchiectasis be researched further, and that use may not be justified unless a person has underlying asthma or obstructed airways.
https://www.archbronconeumol.org/en-dual-broncodilator-triple-therapy-in-articulo-S0300289623002284 (and others.)

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ooops I just looked it up and Symbacort (formoterol part) is a Laba not a Lama - these things are so hard to remember! "Both Symbicort and Breo contain a combination of two active ingredients, an inhaled corticosteroid and long-acting beta2-agonist. Symbicort contains budesonide and formoterol. Breo contains fluticasone and vilanterol." I see these are different version of a corticosteroid and different beta2agonists....but I wonder what the real difference is? Breo is once a day.

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Mentor
Sue, Volunteer Mentor | @sueinmn | May 25 10:27pm
In reply to @liz440 "I have an appt in JUne and I am going to ask for a switch from..." + (show)
@liz440

I have an appt in JUne and I am going to ask for a switch from laba (breo) to lama (the one you are taking - simbacort (sp?) and see if it will help the excess mucus I have. Thanks for that info.

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Hi Liz - Symbicort, (or generic Breyna) is an LABA plus ICS. I will be asking my new pulmonologist if he recommends change to an LAMA.
Breo uses fluticasone, which has been blamed more often for steroid-induced reduced immunity, while Symbicort uses budosenide which I believe is considered a safer long term medicine, but I cannot find the article about it right now.
Long term use of all steroids, oral or inhaled, has risks, so I would like to move on if I can.

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1 reply
liz440 | @liz440 | May 26 7:07am

I have yearly immunoglobulin tests (IGM IGA IGE IGA etc and some other test I forget which one which would show if I had any problems with immunity and they are always normal and as I have said before I have been on low dose prednisone for 40 or more years both oral and inhaled. I say this just to reassure people that you can live with steroids. (Maybe I'm just lucky that I made it to 78?)

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scoop | @scoop | May 26 11:44am
In reply to @sueinmn "Hi Liz - Symbicort, (or generic Breyna) is an LABA plus ICS. I will be asking..." + (show)
@sueinmn

Hi Liz - Symbicort, (or generic Breyna) is an LABA plus ICS. I will be asking my new pulmonologist if he recommends change to an LAMA.
Breo uses fluticasone, which has been blamed more often for steroid-induced reduced immunity, while Symbicort uses budosenide which I believe is considered a safer long term medicine, but I cannot find the article about it right now.
Long term use of all steroids, oral or inhaled, has risks, so I would like to move on if I can.

Jump to this post

Here’s one Study about risks of pneumonia — fluticasone versus Budesonide
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629914/

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scoop | @scoop | May 26 11:59am

From the web:

### Beclomethasone Dipropionate (HFA)
- **Low dose:** 80-240 mcg/day
- **Medium dose:** 240-480 mcg/day
- **High dose:** >480 mcg/day

### Budesonide
- **Low dose:** 200-400 mcg/day
- **Medium dose:** 400-800 mcg/day
- **High dose:** >800 mcg/day

### Fluticasone Propionate (HFA or DPI)
- **Low dose:** 100-250 mcg/day
- **Medium dose:** 250-500 mcg/day
- **High dose:** >500 mcg/day

### Mometasone Furoate
- **Low dose:** 110-220 mcg/day
- **Medium dose:** 220-440 mcg/day
- **High dose:** >440 mcg/day

### Ciclesonide
- **Low dose:** 80-160 mcg/day
- **Medium dose:** 160-320 mcg/day
- **High dose:** >320 mcg/day

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