Your Sister's Inhalers - What Each One Does

1. Foracort 400 - Formoterol Fumarate + Budesonide (Cipla)

• Type: Long-Acting Beta-2 Agonist (LABA) + Inhaled Corticosteroid (ICS) - combination
• How it works: Formoterol relaxes and opens the airways (bronchodilator), while Budesonide is a steroid that reduces airway inflammation and swelling
• Used for: Maintenance (daily) control of asthma and COPD. The "400" refers to 400 mcg of budesonide per dose, making this a medium-to-high strength controller
• When to use: Regular daily doses as prescribed - this is a preventer, not a rescue inhaler. As noted in Goldman-Cecil Medicine, budesonide-formoterol combination is also approved as "as-needed" therapy in some countries

2. Saliprair L 20 - Levosalbutamol + Ipratropium Bromide (50+20 mcg/actuation)

• Type: Short-Acting Beta-2 Agonist (SABA) + Short-Acting Muscarinic Antagonist (SAMA) - combination
• How it works: Levosalbutamol (the active form of salbutamol) rapidly opens the airways; Ipratropium blocks the nerve signals that cause airway constriction and excess mucus
• Used for: Acute relief of bronchospasm - this is a rescue inhaler for when symptoms flare up (wheeze, breathlessness, chest tightness)
• When to use: When she feels breathless or has an attack. CFC-free HFA formulation

3. OVR-9 (Precept) - Tiotropium Bromide 9 mcg

• Type: Long-Acting Muscarinic Antagonist (LAMA) - once-daily anticholinergic
• How it works: Blocks muscarinic (M3) receptors in the airways for 24 hours, keeping the airways open all day and reducing mucus secretion
• Used for: Once-daily maintenance bronchodilation. Primarily a COPD drug, but also used in severe or uncontrolled asthma as add-on therapy. Goodman & Gilman's Pharmacological Basis confirms tiotropium is now used in severe asthma management in addition to COPD
• When to use: Once daily, every morning - long-term controller

4. Precept-S 250 - Fluticasone Propionate + Salmeterol 250 mcg

• Type: ICS (Inhaled Corticosteroid) + LABA (Long-Acting Beta-2 Agonist) - combination (same class as Foracort but different molecules)
• How it works: Fluticasone is a potent anti-inflammatory steroid; Salmeterol is a long-acting bronchodilator (12-hour duration)
• Used for: Maintenance control of asthma. This is equivalent to Advair/Seretide internationally
• When to use: Twice daily as a regular controller inhaler

Summary Table

Important Notes

• Your sister has 3 controller inhalers and 1 rescue inhaler - this suggests she has moderate-to-severe allergic bronchitis/asthma requiring step-up therapy
• The Saliprair L 20 (rescue inhaler) should only be used for sudden symptoms, not regularly
• Foracort and Precept-S both contain an ICS + LABA - the doctor has prescribed two such inhalers, which may be a step-up strategy or a transition plan. Make sure she follows her doctor's instructions on whether to use both or just one
• All inhalers are Rx (prescription) medications - she should not stop or change doses without consulting her doctor
• Proper inhaler technique is important for the medicines to reach the lungs effectively

Patient Details

• Name: Maloth Thanuja | Age: 29 years | Sex: Female
• Height: 155 cm | Weight: 48 kg | Smoker: No
• Date: 16/07/2026

Key Values - What the Numbers Say

Official Report Findings

Pre-Medication Report:

• Early Small Airway Obstruction is present
• Spirometry shows Moderate Restriction (FVC% < 65)
• FEV1/FVC% > 70 (it is 53, which actually means obstruction is present - the machine flagged the restrictive FVC pattern)

Final Interpretation (handwritten):

"Mixed Obstructive and Restrictive Disorder - Correlate Clinically"

• COPD Severity post-bronchodilator: Restrictive pattern noted

What "Mixed Obstruction + Restriction" Means

• The airways are narrowed (bronchospasm, mucus, inflammation)
• Air flows out slowly and incompletely
• This is consistent with her allergic bronchitis / asthma

• The total volume of air she can move is also reduced
• This means her lungs cannot fully expand
• In the context of asthma without smoking history, this likely reflects air trapping (gas gets trapped behind blocked small airways, reducing the usable lung volume), or a co-existing condition like chest wall stiffness

Severity Assessment

What This Means for Her Treatment

• The severe mixed pattern means she needs both an anti-inflammatory (steroid) and multiple bronchodilators working together
• The tiotropium (OVR-9) in particular makes sense here - it helps keep airways open 24 hours and is especially useful when both obstruction and restriction are present
• The low MVV (11%) suggests she may feel very breathless with even light activity

⚠️ Important: These values are pre-bronchodilator. Post-bronchodilator values are missing (marked "--") which means either the test was not done with bronchodilator, or results were not recorded. A post-bronchodilator test would tell the doctor how much of the obstruction is reversible with her inhalers. Please ask her doctor about this, as it is important for adjusting treatment.