Alternative to Symbicort inhaler

[Shelydon]

After using Breo for 8 years, I switched to symbicort and it worked much better. Last fall was able to get symbicort using a coupon for about $60. In January the coupon expired in the company did not issue anymore and with insurance my current inhaler price is $200 a month. This is not sustainable. Has anyone previously used symbicort and found another inhaled steroid that works as well for them? 

[Tap]

Symbicort went generic this year. Have you tried pricing the generic on your insurance?

[Shelydon]

23 minutes ago, Tap said:

Symbicort went generic this year. Have you tried pricing the generic on your insurance?

Yes! I should have specified that I'm paying $200 a month for the generic right now. I think that's why there's no longer coupons from the company, they are assuming that the price will be significantly cheaper for the generic, but my insurance doesn't cover it. 

[SoCal_Bear]

8 minutes ago, Shelydon said:

Yes! I should have specified that I'm paying $200 a month for the generic right now. I think that's why there's no longer coupons from the company, they are assuming that the price will be significantly cheaper for the generic, but my insurance doesn't cover it. 

have you checked the pricing for the generic at Costco or Walmart? You don't have to be a member to use Costco pharmacy. Or from a mail order pharmacy?

 

Edited June 25, 2021 by calbear

[Tap]

18 minutes ago, Shelydon said:

Yes! I should have specified that I'm paying $200 a month for the generic right now. I think that's why there's no longer coupons from the company, they are assuming that the price will be significantly cheaper for the generic, but my insurance doesn't cover it. 

I would talk to the doctor.  They know your medical history and can look at your formulary and make suggestions that would be good for you. There is a patient assistance program for brand name Symbicort, but they are usually income based. You could reach out to them to see if you would qualify. 

[prairiewindmomma]

Breo is fluticasone + another chemical.

Symbicort is budesonide + another chemical.

If you think the benefit has been primarily been from going from fluticasone to budesonide (this was true for me), you might try asking for a Rx for just generic Pulmicort/budesonide. The cash price for that is <$40 at our Kroger chain grocery store or $55 at Costco. (Use good Rx for the best prices near you.)

I can get by with a cheaper inhaler except when ill or for the month of June.

[popmom]

You could look into Asmanex(it worked well for me), but my insurance stopped covering that one. It is a steroid only—without a long acting bronchodilator. I believe Pulmicort is the same—no long acting bronchodilator. I guess an alternative to Symbicort would be Advair. Not sure if there’s a generic for that.

ETA Asmanex worked better than Pulmicort for me.

Edited June 25, 2021 by popmom

[prairiewindmomma]

The Advair generic is Wilexa and runs about $100. 🙂 It’s fluticasone + a bronchiodilator.

[Shelydon]

Thank you! I'll look pulmicort.  I tried the new trelegy ellipta, but it just doesn't work for me. I have cough variant asthma and it seems like a lot of the inhalers don't work for that. 

[popmom]

45 minutes ago, Shelydon said:

Thank you! I'll look pulmicort.  I tried the new trelegy ellipta, but it just doesn't work for me. I have cough variant asthma and it seems like a lot of the inhalers don't work for that. 

Mine is cough variant, too! I’ve never “met” anyone else who has it. Took way, way too long to get a diagnosis. I finally had a PCP in San Antonio take me seriously and he sent me to a pulmonologist and requested I have a methacholine challenge. I’m not exaggerating when I say Asmanex and Medrol Dose Packs changed my life. 

[Carol in Cal.]

19 minutes ago, popmom said:

Mine is cough variant, too! I’ve never “met” anyone else who has it. Took way, way too long to get a diagnosis. I finally had a PCP in San Antonio take me seriously and he sent me to a pulmonologist and requested I have a methacholine challenge. I’m not exaggerating when I say Asmanex and Medrol Dose Packs changed my life. 

I have it, too.  I finally realized that I really, really need to nip anything that contributes to it in the bud before it takes hold because once it does, I either have it for months or have to take a strong course of oral steroids.  Nothing else touches it.

So I hit the Naselcrom and Allegra hard during allergies, and Sudafed too if needed.  

And I carry cough drops wherever I go.  

And I take the maximum strength Mucinex, which is the only non drowsy cough medicine that touches this.

And I aggressively treat reflux.

And always have a rescue inhaler with me.

 

Edited June 25, 2021 by Carol in Cal.

[popmom]

1 minute ago, Carol in Cal. said:

I have it, too.  I finally realized that I really, really need to nip anything that contributes to it in the bud before it takes hold because once it does, I either have it for months or have to take a strong course of oral steroids.  Nothing else touches it.

So I hit the Naselcrom and Allegra hard during allergies, and Sudafed too if needed.  

And I carry cough drops wherever I go.  

And I take the maximum strength Mucinex, which is the only non drowsy cough medicine that touches this.

And I aggressively treat reflux.

And always have a rescue inhaler with me.

 

Mine isn’t triggered by allergies weirdly. Mine is triggered by weather and climate. Dry conditions = misery. And of course any upper respiratory infection. 
 

My doctor never fails to remind me to keep a rescue inhaler on hand. “Cough variant asthma is STILL asthma.” 😉 

[prairiewindmomma]

The kids and I are all cough variant also, fwiw.

Interestingly, it was also my PCP in San Antonio that helped me break my cycle of pneumonia after asthma attacks through prednisone injections (versus pills which don’t hit it hard enough). He was one of the best doctors I have ever had. Fwiw, we followed that up with the pneumonia vaccines for adults and it has really helped. 

 

 

[Shelydon]

9 hours ago, popmom said:

Mine is cough variant, too! I’ve never “met” anyone else who has it. Took way, way too long to get a diagnosis. I finally had a PCP in San Antonio take me seriously and he sent me to a pulmonologist and requested I have a methacholine challenge. I’m not exaggerating when I say Asmanex and Medrol Dose Packs changed my life. 

I haven't heard of Asmanex!  I see an allergy and asthma doc, but wonder if I would benefit from a pulmonologist instead.

 

[TravelingChris]

8 hours ago, popmom said:

Mine isn’t triggered by allergies weirdly. Mine is triggered by weather and climate. Dry conditions = misery. And of course any upper respiratory infection. 
 

My doctor never fails to remind me to keep a rescue inhaler on hand. “Cough variant asthma is STILL asthma.” 😉 

Mine is triggered by allergies (though not since I have started Duplixent=yeah, yeah- treats my exczema too).  Also illnesses (and due to pandemic, I haven't been sick since Feb 2020 which is a record long time for me), pollution and scents like perfume, cigarette smoke, chlorox, and many others, and I think that is it.

But my allergies are year round since I not only react to some pollens (Not sure which since allergist only checks about 2- tree varieties and we have over 200 in our state) but also to a category of molds that is both the type you get on moldy bread and also the kind you have outdoors with decay.  So the mold is mostly year round unless we have a drought.

[Shelydon]

Mine is triggered by allergies and illness. I am going to try Xyzal for allergies as soon as I run out of the Zyrtec I'm taking. 

[Shelydon]

Those that deal with cough variant asthma-- how often do you have to do an albuterol breathing treatment? I am finding that I need to do a breathing treatment 4-5  times a week usually around 3:00 in the afternoon in order to keep from coughing in the evening. 

[prairiewindmomma]

56 minutes ago, Shelydon said:

Those that deal with cough variant asthma-- how often do you have to do an albuterol breathing treatment? I am finding that I need to do a breathing treatment 4-5  times a week usually around 3:00 in the afternoon in order to keep from coughing in the evening. 

I only need breathing treatments when ill or exposed to pet hair. All of my other allergens are tolerable. 
 

Have you seen a proper pulmonologist? You don’t sound like your current regime is giving you adequate control.

[prairiewindmomma]

I would be super curious to see what your peak flow readings are, btw.

[popmom]

1 hour ago, Shelydon said:

Those that deal with cough variant asthma-- how often do you have to do an albuterol breathing treatment? I am finding that I need to do a breathing treatment 4-5  times a week usually around 3:00 in the afternoon in order to keep from coughing in the evening. 

 

2 minutes ago, prairiewindmomma said:

I only need breathing treatments when ill or exposed to pet hair. All of my other allergens are tolerable. 
 

Have you seen a proper pulmonologist? You don’t sound like your current regime is giving you adequate control.

I agree with Prairiewindmomma. The only times I’ve truly needed albuterol were during a significant exacerbation or after surgeries (due to anesthesia). Albuterol has never helped the coughing. Only steroids.

Edited June 29, 2021 by popmom

[prairiewindmomma]

Well, and there is a significant difference between needing an inhaler versus needing a breathing treatment. Super significant. 
 

I have used my inhaler twice this month. It’s my worst month, allergy wise. When I swam regularly, I might need a pre-exercise puff. The last time I needed a nebulizer treatment, though, was December 2019. I was super sick and needed it every 2-4 hours for about 3 days. 
 

But daily nebulizer treatments? My pulmonologist would have my head if I hadn’t called in on that one.

I do realize there are people with COPD or the like who need that. I do. But generally you know you do and you have been through a lot of testing to confirm lung function and have a pretty strong treatment plan. Not sure of your background, OP, which is why I mentioned pulmonologist.

[TravelingChris]

10 hours ago, Shelydon said:

Those that deal with cough variant asthma-- how often do you have to do an albuterol breathing treatment? I am finding that I need to do a breathing treatment 4-5  times a week usually around 3:00 in the afternoon in order to keep from coughing in the evening. 

If I was having so many issues, I would be needing to change my treatment.  Agree with others, go to pulmonologist.

[Paige]

12 hours ago, Shelydon said:

Those that deal with cough variant asthma-- how often do you have to do an albuterol breathing treatment? I am finding that I need to do a breathing treatment 4-5  times a week usually around 3:00 in the afternoon in order to keep from coughing in the evening. 

Only when I'm exacerbated for some reason but then it can be like 4-5 times a day!

I'd go back to the doctor. You may need a shot or something to get it under control. When my acts up, it can be months before it calms down. I really don't think it would ever calm down without sucking it up and getting a shot or 2. When was the last time it was under control and can you pinpoint a cause for exacerbation in the last 6 months? 

[Shelydon]

15 hours ago, prairiewindmomma said:

Well, and there is a significant difference between needing an inhaler versus needing a breathing treatment. Super significant. 
 

I have used my inhaler twice this month. It’s my worst month, allergy wise. When I swam regularly, I might need a pre-exercise puff. The last time I needed a nebulizer treatment, though, was December 2019. I was super sick and needed it every 2-4 hours for about 3 days. 
 

But daily nebulizer treatments? My pulmonologist would have my head if I hadn’t called in on that one.

I do realize there are people with COPD or the like who need that. I do. But generally you know you do and you have been through a lot of testing to confirm lung function and have a pretty strong treatment plan. Not sure of your background, OP, which is why I mentioned pulmonologist.

I have never had a Albuterol inhaler work. 🤷‍♀️

 

The nebulizer is a lifesaver though.

[Shelydon]

4 hours ago, Paige said:

Only when I'm exacerbated for some reason but then it can be like 4-5 times a day!

I'd go back to the doctor. You may need a shot or something to get it under control. When my acts up, it can be months before it calms down. I really don't think it would ever calm down without sucking it up and getting a shot or 2. When was the last time it was under control and can you pinpoint a cause for exacerbation in the last 6 months? 

Yes. If I get sick, the I will need to use it 4-5 times a day.  My asthma/allergy doctor will prescribe Prednisone when I need it . I really can't figure out what has changed, but I can't find an prevention inhaler that works well enough that I don't also need Albuterol. 

Edited June 29, 2021 by Shelydon

[Paige]

23 minutes ago, Shelydon said:

Yes. If I get sick, the I will need to use it 4-5 times a day.  My asthma/allergy doctor will prescribe Prednisone when I need it . I really can't figure out what has changed, but I can't find an prevention inhaler that works well enough that I don't also need Albuterol. 

Are you using albuterol 4-5 days while on symbicort too or just with the substitute? They keep trying to switch me off symbicort too but I notice an increase in symptoms immediately with any switch. Even Breo wasn’t good. 
 

My doctor would say that needing it albuterol that much is an exacerbation and he’d give me a shot. Sometimes it takes two shots over a period of a few weeks. He would be upset if I didn’t come in and tell him about it. Could it be the heat, smoke from some source, pollen? 

 

[Shelydon]

8 minutes ago, Paige said:

Are you using albuterol 4-5 days while on symbicort too or just with the substitute? They keep trying to switch me off symbicort too but I notice an increase in symptoms immediately with any switch. Even Breo wasn’t good. 
 

My doctor would say that needing it albuterol that much is an exacerbation and he’d give me a shot. Sometimes it takes two shots over a period of a few weeks. He would be upset if I didn’t come in and tell him about it. Could it be the heat, smoke from some source, pollen? 

 

This is while on Symbicort. Or any other preventative. By 9:00 at night I'm coughing constantly.  I went back through my list and I've tried 7 inhalers. I'll call and make an appointment. My doctor is an allergist who also specializes in asthma. I could potentially switch to a pulmonologist. 

[TravelingChris]

1 hour ago, Shelydon said:

I have never had a Albuterol inhaler work. 🤷‍♀️

 

The nebulizer is a lifesaver though.

Are you using a spacer?  Albuterol by itself is 1.  With spacer, it is 9 x more effective.  And nebulizer makes it 27 x more effective.

[TravelingChris]

You sound like a person who needs to get on one of the biologics- I believe there are three.  My dd is on Nucala and I am on Duplixent.

[prairiewindmomma]

IME, pulmonology is WAY better than allergy/asthma docs.  The allergy/asthma doctors were great at testing for allergies and for my mild kids, but once things got complex, pulmonology was the way to go.

If you haven't had a reflux rule-out, that's something to consider also when you're cough-variant. If you are refluxing enough that you're causing tissue damage, it can really irritate those airways.  I've found adding famotidine helpful, not only because it is an acid reducer (PEPCID AC), but because it's also a H2 inhibitor.

[TravelingChris]

1 minute ago, prairiewindmomma said:

IME, pulmonology is WAY better than allergy/asthma docs.  The allergy/asthma doctors were great at testing for allergies and for my mild kids, but once things got complex, pulmonology was the way to go.

If you haven't had a reflux rule-out, that's something to consider also when you're cough-variant. If you are refluxing enough that you're causing tissue damage, it can really irritate those airways.  I've found adding famotidine helpful, not only because it is an acid reducer (PEPCID AC), but because it's also a H2 inhibitor.

I am also on famotidine too.

[Shelydon]

1 hour ago, TravelingChris said:

Are you using a spacer?  Albuterol by itself is 1.  With spacer, it is 9 x more effective.  And nebulizer makes it 27 x more effective.

Yes. I have a spacer. 

[Shelydon]

Went to my asthma/allergy doctor yesterday.  She is having me try Airduo Digihaler.  She prefers for patients to use a nebulizer when they are coughing a lot vs. oral steroids.  I'll update how it works in about a week.

[prairiewindmomma]

Airduo is the Advair quasi-generic. It has a touch less salmeterol. I just had to look it up—did not know this was out and it’s going to save me $$$, even compared to Wixela (Advair generic). Thanks for this!