Re: Flovent, steroid dependent

[Guest guest]

The best I can offer is that according to my pulmo, when I was on

Advair 500/50 twice daily (=a total of 1000 mcg steroid as

fluticasone) plus Flovent 220, 2 puffs twice daily (a total of 880

mcg fluticasone), I was absorbing an amount of fluticasone

systemically (whole body) equivalent to 25 mg prednisone. I don't

know that you can calculate that out for your dose and be accurate,

since it may well be that for the first certain amount of Flovent you

may not absorb any significant amount but if you go over that

threshhold, you absorb a lot.

I haven't been able to find those numbers myself in a limited search

of the medical literature and I don't have the steam to do a thorough

one. I'm seeing my pulmo Tuesday and will ask him for a reference.

Fran

--- In , " ronaldcrpntr " <cowtrail@...>

wrote:

>

> My Pulmo has diagnosed me as " steroid dependent asthma " . He is very

happy with my Xolair

> response, not as good as I expected but it gave me a limited life

back, which I am happy

> with. I am down to 20 mg of Prednisone daily and my Pulmo does not

feel I should go any

> lower, for now anyway. I tried and big time symptoms came back.

>

> I got to thinking (probably not a good thing, LOL), I am also

taking a Flovent inhaler, 220

> mcg, two puffs, twice daily. How much steroids does this add to my

medicine intake daily. I

> have looked on the internet and the insert in the Flovent to no

avail. Does anyone know, at

> least the approximate intake of steroids from the Flovent inhaler?

>

> Ron

>

[Guest guest]

Thanks Fran,

At my last visit to my Pulmo (he's also my PCP and the one who put me

on Xolair) he said he did not want me dropping below 20 mg.

Prednisone. I also have a bunch of negative adverse reactions to the

evil candy, I guess that's why we call it evil, LOL. In previous

tapers, my pulmo seems to allow larger tapers, 5 mg at a time. I have

been using flovent but I never considered it an important source for

more steroids (I assumed it's delivery and consequent absorption was

minimal for steroids). When I started checking I could not find an

equivalent but it did talk about tapering off just like Prednisone.

Although the exact amount of steroids from Flovent may be just an

" approximate " , I will now be much more aware of my inhaler usage, it

seems it's overall effect may be more important then I previously

thought.

This also reinforces the need for a discussion with my Pulmo. He

" inherited " me from a PCP that retired, he may feel that all

discussions took place between me and my old Dr, they did not. When I

started with my problems my old Dr said, " you have adult onset

asthma, here's two inhalers, take them as prescribed " , that was it. I

did not even believe him when he told me that I had asthma (I'm a

terrible patient but I'm trying to change my wicked ways). With my

new Pulmo it is different, he's great, but I do have to address the

other Dr and lack of information without seeming to diminish the old Dr.

By the way, I've been hospitalized twice with asthma related stuff

(They told me they thought I was going to die the first time) but

have not been hospitalized in the last year. I have been taking

Xolair for approximately two years and for me any perceived side

effects are:

1. worth it (I hate it when I die)

2. can usually be traced back to other medications I'm taking

Ron

On Jun 30, 2007, at 11:38 PM, tiredofsteroids wrote:

> The best I can offer is that according to my pulmo, when I was on

> Advair 500/50 twice daily (=a total of 1000 mcg steroid as

> fluticasone) plus Flovent 220, 2 puffs twice daily (a total of 880

> mcg fluticasone), I was absorbing an amount of fluticasone

> systemically (whole body) equivalent to 25 mg prednisone. I don't

> know that you can calculate that out for your dose and be accurate,

> since it may well be that for the first certain amount of Flovent you

> may not absorb any significant amount but if you go over that

> threshhold, you absorb a lot.

>

> I haven't been able to find those numbers myself in a limited search

> of the medical literature and I don't have the steam to do a thorough

> one. I'm seeing my pulmo Tuesday and will ask him for a reference.

>

> Fran

>

>

> >

> > My Pulmo has diagnosed me as " steroid dependent asthma " . He is very

> happy with my Xolair

> > response, not as good as I expected but it gave me a limited life

> back, which I am happy

> > with. I am down to 20 mg of Prednisone daily and my Pulmo does not

> feel I should go any

> > lower, for now anyway. I tried and big time symptoms came back.

> >

> > I got to thinking (probably not a good thing, LOL), I am also

> taking a Flovent inhaler, 220

> > mcg, two puffs, twice daily. How much steroids does this add to my

> medicine intake daily. I

> > have looked on the internet and the insert in the Flovent to no

> avail. Does anyone know, at

> > least the approximate intake of steroids from the Flovent inhaler?

> >

> > Ron

> >

>

>

>

[Guest guest]

Hi,

I think if any of us have been on long-term prednisone as well

as an inhaled steroid we're 'steroid dependent'. My pulmo used me

being his 'steriod dependent asthmatic' to let a nurse know that I

really did need to stay overnight following my exploratory

bronchoscopy about 1.5 years ago (one nurse told me bronchoscopies

are ALWAYS outpatient). I don't really think that term changes

treatment in any way, in my case it was used one time to 'scare' a

nurse, and I was not supposed to hear it. In a 'google' search for

steroid equivalents, the first page that comes back as a result is a

chart comparing the different oral/ injectable steroids. I (even

extensively searching) cannot seem to find any info on what ICS

prednisone equivalents are.

I am currently on Pulmicort Turbuhaler 200mcg, 3 puffs twice

daily. The Turbuhaler is phasing out and the 'replacement' is

Pulmicort Flexhaler, which I'm switching to later this month. The

Flexhaler comes as a 180mcg dose form, my pulmo prescribed 2 puffs of

the 180mcg kind twice daily, and I thought he had gone insane and

dropped my ICS. When I called him on Friday he said to basically

ignore the numbers, that the Flexhaler particles are absorbed by the

lungs better so that 600mcg of the Turbuhaler is equivalent to the

360mcg of the flexhaler. So, different ICS definitely are dosed

differently (even the same medicine, they are both budesonide), I

would def be interested in knowing what my ICS dose is equivalent to

in Prednisone.

My pulmo said when I saw him in June, that today (July 1st, the

pollens are hopefully done peaking) I could drop my oral Prednisone

from 15mg every other day to 10mg every other day, I've been at 15mg

every other day since 11/1/06. Today is a Prednisone day, and I

already (some 9 hrs. into the change) feel a difference, like my

lungs are looking for more. But I see my pulmo on July 24th (which is

an 'off' day, my pulmo wanted it that way) and he said that if I'm

still having a rough time 3+ weeks into the change, that we'll go

back to 15mg every other day, and he'll leave my dosage alone. 15mg

every other day of Prednisone is a far cry from the 90mg/3x day I was

on about 2 yrs. ago, so I know that if 10mg really makes my

lungs 'wild' then 15mg/every other day will just be what I have to

deal with, and apparently I'm 'very steroid dependent' if that's even

a term (lol).

I don't know - I think we should all write an 'asthma education

series' lol one of the chapters has to be 'everything you ever wanted

to know (and some things you didn't) about the wonderful world of

steroids'. This is what a lack of sleep produces, sorry for my

rambling.

Meagan

> >

> > My Pulmo has diagnosed me as " steroid dependent asthma " . He is

very

> happy with my Xolair

> > response, not as good as I expected but it gave me a limited life

> back, which I am happy

> > with. I am down to 20 mg of Prednisone daily and my Pulmo does

not

> feel I should go any

> > lower, for now anyway. I tried and big time symptoms came back.

> >

> > I got to thinking (probably not a good thing, LOL), I am also

> taking a Flovent inhaler, 220

> > mcg, two puffs, twice daily. How much steroids does this add to

my

> medicine intake daily. I

> > have looked on the internet and the insert in the Flovent to no

> avail. Does anyone know, at

> > least the approximate intake of steroids from the Flovent inhaler?

> >

> > Ron

> >

>