A couple of months ago my daughter was prescribed a new asthma medication which is a combined prophylactic and long-acting reliever.
While the brand name here is Seretide, I’ll give people the generic names of the actual drugs in case it’s marketed under a different name elsewhere.
Each dose contains 250 micrograms of FLUTICASONE PROPIONATE and 50 micrograms of SALMETEROL (as XINAFOATE). She takes two doses per day in addition to 1-2 puffs of *Ventolin[i/] (100 micrograms SALBUTAMOL B.P.) three times per day.
Since she’s been taking the Seretide, she’s become increasingly emotionally labile and I’m wondering whether this could be a side effect of the corticosteroids. I can’t find anything related to mood listed as a side effect of corticosteroids either in the packaging or in my personal reference books on medications, but I’m aware that mood swings can be a side effect of using other forms of steroids.
My daughter is on a rather high dose of Seretide for her age and size, and as she’s due for an asthma review next week I’m interested in finding any information people might be able to point me towards relating to this issue so I can dicuss it with her physician - taking her off steroids is simply not an option, but reducing her dosage or switching to another preventative medication might improve everyone’s life if there is any proven connection between mood swings and her current medication.
Thanks in advance for any help you can give.
In my experience, Seretide was wonderful stuff. It was the only drug treatment that came close to controlling my asthma so I’d urge you to make elimination of it a last resort. The only warning I was given by the specialist was that the steroid component (Fluticasone) can promote fungal infection. Therefore, it was important to rinse thoroughly after a dose.
Read the literature that came with the puffer/accuhaler. It lists everything that can go wrong. OTOH, the doctor will only tell you what very possible given the patient’s situation. I don’t recall any behavioural side effects of the treatment noted in the literature but then again, I’ve been asthma free for nearly a year now and research may have revealed some surprises.
There are two possibilities as I see it.
First, it may be the steroid in the inhaler is having emotional side effects. Oral steroid certainly can do this. However, it is extremely rare that the inhaled steroids would do this.
Second (and, I think, more likely) the treatment is working and your daught is feeling better. Therefore, she has more energy to spare on expressing herself, as opposed to just simply trying to breathe. So, ironically, this “emotional lability” may, in fact, be a sign of improved health.
In any case - when she has her review bring up her change in behavior
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Asthma sufferers will want to know more 
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‘Free’ as in ‘no overt symptoms because they’re controlled with meds’ or ‘free’ as in ‘medically diagnosed as having no asthma’ ? If it’s the latter, what caused the asthma’s disappearance?
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Good point. Free as in medically diagnosed as so. No symptoms whatsoever. The reason I didn’t say why was because I’d already mentioned the breathing technique that I’d used to correct it in another recent thread. I didn’t want to come across as some kind of alternative medicine zealot and so I was waiting to see if reprise would enquire.
The technique is called the Buteyko Method. A regime of breathing exercises developed by a Soviet scientist in the seventies and eighties IIRC. It works on the basis that asthma is the body’s overresponse to overbreathing. There is also the idea that for oxygen to efficiently diffuse across the respiratory surfaces, there needs to be a certain amount of CO2 present. However, overbreathing causes even that to be flushed away so to speak.
I became involved with it through a girl I’d been in a relationship with. She’s a researcher into asthma and got me into the Australian trials for Fluticasone and Salmeterol (later combined into the one med: Seretide). It helped a lot as I said, but later one of her colleagues was researching a technique that allowed many to do away with meds altogether. Alternative medicine had always been something I’d been sceptical about but my attitude softened in view of the reputation of the institution doing the study i.e. there was little chance of quackery slipping through their research review boards.
The method has made big inroads in Australia which has one of the highest incidences of asthma in the world. A Google search limited to to the .au TLD will yield a number of places where reprise can find out more about the method and where she can get instruction. If anybody in Melbourne is curious, I can lend them the instructional tape so they can get an idea of what it’s all about.
Actually, I’m aware of Buteyko and something I want to try as a supplementary therapy once my daughter’s asthma is under some reasonable control.
My daughter was a very bad (as in hourly nebs of Ventolin and Atrovent plus two hourly nebs of Intal, and still needed hospitalising a few times a year) asthmatic when we lived on the Far North Coast of NSW in a sub-tropical climate.
She was asthma-free (totally) for a period of 6 years following our move to Sydney. Her first (reasonably mild) attack in 6 years occured during the Christmas bushfires (we’re close to the Blue Mountains and the smoke was unbelievable for a couple of weeks). She was put on steroid inhalers for a couple of weeks following that but the doctor didn’t feel it was necessary for them to be continued. Of course, he didn’t foresee that we’d then go on to have a sub-tropical summer. ATM we’re looking at 6 months on steroids and long acting preventatives - largely to get her through the cold and flu season (she had a really bad case of croup a few weeks ago which saw her put on prednisone in addition to the Seretide and Ventolin).
I’m not cynical about Buteyko, but at the moment the priority is getting her asthma under control and then looking at the options for keeping her asthma-free.
I completely empathise. I just didn’t want to look like some Buteyko fundamentalist, following you from thread to thread or anything like that. People like that just make me feel a little weird and dead set against finding out what they’re on about. Get your girl’s asthma under control with the Seretide first definitely. The technique can be used in conjunction with meds but the emphasis is on using the technique to gain relief. Failing that, then reach for the accuhaler/nebuliser/puffer.
The problem is that some of these drugs are a bandaid solution in a sense. They artificially dilate the bronchial tubes when it’s the body that is closing them down in response to the low volume of CO2 in the lungs. Contrary to popular opinion, asthma is a condition that makes EXhalation difficult. You can get air in, it’s just that your body wants you to hold it while you build up some CO2 metabolic by-product to facilitate O2 diffusion. Next time your daughter has an attack, notice the way her chest is puffed out. It’s termed over inflation and is a secondary indicator of asthma. It means she’s having problems blowing the air out so that she can replace it.
Sorry if I sound like some scary religious freak who is telling you to cast off your pharmaceuticals. That’s the absolute last thing I’d suggest. No accredited Buteyko instructor will tell you that either and they’ll be totally in favour of working with a good asthma plan that includes meds especially in the early stages.
Best of luck and I hope she has the same success with the Seretide that I did.