Converting fluticasone to budesonide

Age 52
Sex M
Height 5'8"
Weight 200
Race white
Duration of complaint 2 months
Location
Any existing relevant medical issues asthma. High blood pressure
Current medications
Advair. Fluticasone. Lorasartin. Advestatin.
I had been couching up yellow mucus from my lungs and it was hard to even complete a sentence I also had eye mucus that had a burning sensation. . So went to acute care to see what they could do a chest xray showed very little. But some hazyness . They put me on steroid, eye drops and antibiotics pills. A week later symptoms started returning. Second time I got steroids, eye drops and a z pak. That helped more. But 10 days later I was feeling it again and breathing issues returned. Same thing 10 days later. 3rd time I got a steroid shot. Nebulizer in office. Xray. And bloodwork. All my counts were good except Eosinophils Absolute was 1.1. 3 days later my physician gave me a zpak and singular . And ordered a cat scan that got denied by insurance. And a scheduled pulmonary 3 months away. After 14 days. My eyes and mucus wheezing is returning. I did my home nebulizer last night helped some. Now he ordered. Albuteral and budesonide.
I have been doing albuteral hit and miss. But doesn't feel like it's in my bronchial. I have had asthma sine birth. But it was 100% controlled for years.
I am sure I missed something. 4 times 4 different people.

Info: 17F, Caucasian, 5'5/165cm 126lbs/57kgs, only current medications are 75mg spironolactone for hormonal acne and 20mg cetirizine (one 10mg tab in the morning, one at bedtime) for allergies
For as long as I can remember, I've had nasal congestion on both sides. I can't remember what it's like to functuonally breathe through my nose. I'm a mouth breather because it's the only way I can breathe, which negatively impacts my sleep quality, and I have to wear a mask at all times outside so people can't see me mouth breathing lol. It's also very uncomfortable; there's a constant feeling of pressure around my nose and eyes.
The oral medications I've tried are (all for at least a couple months, double the typical daily dose with permission from my doctor): -Allegra -Zyrtec (what I'm currently using) -Claritin -Hydroxyzine hcl (haven't tried the pamoate version)
The nasal sprays I've tried are (1-2 sprays in each nostril, twice a day): -Nasonex (mometasone) -Nasacort (triamcinolone) -Flonase (fluticasone) -Generic rhinocort (budesonide) I've never used any sprays containing phenylephrine or oxymetazoline, so I don't think it's possible to be rebound congestion.
And nothing has helped the congestion. I have seen improvement with red, itchy eyes and an itchy throat/roof of my mouth (I had an allergy panel done because I thought I was allergic to my cats, but apparently it's a dust mite allergy), but the congestion stays no matter what. When I look up my nose, the nasal walls(?) are always bright red and so swollen they're pressing together so no air can get through. At night, if I use breathe right strips, I can just barely breathe through my nose which reduces the dry throat and drooling I always wake up to, but it's not enough to be comfortable.
What can I do? Does this seem like something that might require surgical correction? Are there other medication classes that I could try? Anything helps, and thank you for reading this :'D

Patient Profile:

• Patient: MB; Age: 60 year; Gender: Male
• Weight: 85 kg; Height: 5 feet 9 inches

Clinical Information:

• Diagnosis: Asthma
• Allergies: Penicillin

Home Medications:

• Albuterol inhaler (90 mcg/puff): 2 puffs Q4H PRN
• Budesonide/formoterol (Symbicort) 160/4.5 mcg: 2 puffs BID
• Montelukast 10 mg PO daily

Hospital medication

• Dexamethasone 1.5 mg PO BID for Asthma Exacerbation

MB's physician wants to convert him to an equivalent dose of prednisone PO, with options for either BID or TID dosing. Which of the correct conversion for MB's current dexamethasone regimen?
View Poll

I recently switched to a fluticasone propion-salmeteroL 250-50 mcg/dose diskus inhaler from a budesonide/formoterol due to my insurance formulary.
I’ve been a lot more tired and needing to use my rescue inhaler more, and I’ve also noticed my stomach has been bothering me. Am I seeing this right that there is milk powder being used in the diskus inhaler? I’m lactose intolerant. Does this bother anyone else?

Possible replacements for ProAir Digihaler (quick-relief inhaler)
Clinical equivalent to ProAir Digihaler:

• ProAir Respiclick (dry powder albuterol inhaler made by Teva)
• ProAir HFA and the authorized generic (albuterol–metered dose inhaler)
• Other generic albuterol HFA inhalers (available as metered dose inhalers but may not be exact equivalents to the ProAir HFA generic, as the inactive ingredients may be different)

Different but equally effective:

• Xopenex HFA and generic (levalbuterol HCI – metered dose inhaler)
• AIRSUPRA (albuterol/budesonide – a quick-relief medicine that contains two medicines)

Possible replacements for ArmonAir Digihaler (inhaled corticosteroid)

• Generic fluticasone propionate HFA (metered dose inhaler – doses are slightly different than ArmonAir but equally effective)
• Generic fluticasone propionate Diskus (dry powder inhaler – dosing may be different than ArmonAir, and the inactive ingredients may not be the same)

Other options that are different but equally effective:

• Arnuity Elipta (fluticasone furoate)
• QVAR RediHaler (beclomethasone dipropionate - breath-actuated inhaler)
• Alvesco (ciclesonide – metered dose inhaler)
• Pulmicort Flexhaler (budesonide – dry powder inhaler)
• Asmanex HFA (mometasone furoate - metered dose inhaler)
• Asmanex Twisthaler (mometasone - dry powder inhaler)
• ARNUITY ELLIPTA (fluticasone furoate – dry powder inhaler; not equivalent to ArmonAir Digihaler)

Possible replacements for AirDuo Digihaler
Advair Diskus, Advair HFA, and their generics may be an option. They contain the same medicine as AirDuo. The doses are different but equal and can be substituted. The inactive ingredients are different.

• Advair Diskus or generic fluticasone propionate/salmeterol Diskus (dry powder inhaler)
• Wixela Inhub (fluticasone propionate/salmeterol – dry powder inhaler)
• Advair HFA or generic fluticasone propionate/salmeterol HFA (metered dose inhaler)

Other options that are different but equally effective:

• Symbicort and generic Breyna (budesonide/formoterol - metered dose inhaler)
• Dulera (mometasone/formoterol – metered dose inhaler)

Your doctor can help you choose the best replacement for you.

How to Use an Asthma Inhaler

Incorrect inhaler use can stop your asthma medicines from getting to your lungs. If your medicine isn’t reaching your lungs, your asthma might be harder to control.
Inhaler mistakes are more common than you might think. Up to 92% of people with asthma use their devices incorrectly.
How you use your inhaler depends on what type it is. There are four types of inhalers:
Metered dose inhaler – This inhaler has a canister that you press down as you breathe in the medicine. It is also commonly used with a spacer or valved holding chamber.
Breath-actuated inhaler - This type of inhaler is not a press-and-breathe inhaler. Taking a fast, deep breath in pulls the medicine out of the device and into your lungs.
Dry powder inhaler—This inhaler delivers medicine as dry powder. It is a type of breath-actuated inhaler, and the medicine is delivered – This inhaler delivers medicine as a dry powder. It is a type of breath actuated inhaler. It delivers the medicine when you inhale. Some of these inhalers are round. These are Diskus inhalers.
Soft mist inhaler: This inhaler delivers medicine in a mist form. You must – This inhaler delivers medicine in a mist form. You have to prepare a new soft mist inhaler by inserting a cartridge and priming it before you use it.

Used to pick up Fluticasone every couple of months with no issues. Now, insurance won't approve Fluticasone AND won't approve Budesonide. So frustrating.

Since I discussed H2RAs, I thought I’d delve into its sibling medication, H1RAs, which are generally referred to as antihistamines. These are the meds that you take when you have an allergy resulting in a histamine release that might cause runny nose, congestion, coughing, sneezing, itchy/watery eyes, hives, etc. (Of course, if you have difficulty breathing and throat swelling, use an Epi pen/go to the ER.)They are divided into the first and second generation namely based on their FDA approval dates, but they also tend to have some different aspects associated with each grouping.
The OGs (1st Gen) cross the blood-brain barrier, so they have the most noticeable drowsiness effects but also potentially stronger effects on blocking histamine in multiple areas of the body (GI tract, blood vessels, respiratory tract). They are also less specific to bind only to histamine receptors so they can also have more anticholinergic (dec digestion, urination, and saliva) effects. Some oral options include diphenhydramine (Benadryl-OTC/Rx), doxylamine (Unisom-OTC/Rx), cyproheptadine (Rx), brompheniramine (Dimetapp-OTC/Rx), chlorpheniramine (Chlorine-Tabs-OTC/Rx), meclizine (Travel Ease-OTC/Rx), dimenhydrinate (Dramamine-OTC/Rx), hydroxyzine (Rx), promethazine (Phenergan-Rx), etc. These meds are meant to be used on an as needed basis unless under medical supervision. Caution should always be taken when driving due to drowsiness potentials.
Second gens are generally considered safer from less risk of drowsiness and drug interactions. Many are also longer lasting, so many can be dosed once every 24 hours continuously. Some oral options include loratidine (Claritin-OTC/Rx), cetirizine (Zyrtec-OTC/Rx), fexofenadine (Allegra-OTC/Rx), desloratidine (Clarinex-OTC/Rx), levocetirizine (Xyzal-OTC/Rx). These are all generally considered to be equally effective, so one is not necessarily recommended over the other. As with any drug, always tell your medical providers if you take any OTC meds because these can still have drug or disease state interactions.
Some antihistamines available in nasal spray and ophthalmic dosage forms include azelaztine (Astelin, Astepro-OTC/Rx, Optivar-Rx), olopatadine (Patanase-Rx, Pataday-OTC/Rx), ketotifen (Zaditor-OTC/Rx). These have less systemic side effects, while still exerting direct action against symptoms.
Other allergy medications include nasal decongestants taken orally like pseudoephedrine (Sudafed-OTC/Rx), and phenylephrine (Sudafed PE-OTC/Rx), or intranasally like phenylephrine (Neo-Synepherine-OTC/Rx), oxymetolazine (Afrin-OTC/Rx) and tetrahydrolozine (Tyzine-Rx). Oral nasal decongestants can increase blood pressure because they work to constrict blood vessels and should not be used long term. They can also cause CNS excitability and heighten anxiety. Nasal spray decongestants should be limited to only 3 days of consecutive use because they can cause symptoms to worsen with continuous prolonged use.
Corticosteroid nasal sprays may also be used to alleviate allergy symptoms from stuffy or runny nose like fluticasone (Flonase-OTC/Rx), mometasone (Nasonex-OTC/Rx), budesonide (Rhinocort-OTC/Rx), beclomethasone (Beconase-Rx), triamcinolone (Nasocort-OTC/Rx), and flunisolide (Rhinalar-Rx). These are listed in order of their general potency. They also have less systemic side effects, while still exerting direct action against symptoms, though it may take several weeks of regular use before their full effects can be felt. While there are some prescription steroid eye drops also available, these are generally reserved for more persistent, severe eye allergy symptoms.
Finally, there are also mast cell stabilizers like cromolyn (Gastrocro-PO-Rx, Nasalcrom-NS-OTC/Rx, and Ophth-Rx) and lukotriene receptor antagonists like montelukast (Singulair). Mast cell stabilizers work to prevent histamines from being released, and lukotriene blockers prevent their inflammatory action involved in allergic reactions and asthma.
There is no evidence that adding medications from the same drug type is beneficial (ex: 2 oral antihistamines), yet a combination of those from different types are often used (ex: oral, nasal, and/or eye drop antihistamines, decongestants, and steroids. As always folks, let your medical providers know if you are using these OTC.
I thought this link had some great info if you want to read more! Allergy medications: Know your options

Actually been having decent results with Flovent. Old insurance was $200 each. New insurance was $0 all last year.
Flovent goes generic only so no longer covered. Get prior authorization approved, says $30 each. But that was for Flovent. Pharmacy changes to generic and tells me $384 each! Yea no. GoodRx I can find it at once place for $187 each. Yea that makes so much sense.
Based on the options from the insurance that are covered and my own research I see a few studies out there on alternatives but not nearly as many.
Here is my list of options so far. Appreciate any input. thanks
Alternative meds given by insurance that all have studies showing effective
Asmanex Hfa Inhaler 13 Gm (mometasone furoate) - covered $0
Alvesco Inhaler 6.1 Gm (ciclesonide) - covered $0
Qvar Redihaler Inhaler 10.6 Gm (beclomethasone dipropionate) - covered $0
Jorveza orodispersible tablet of budesonide - approved for EoE in Europe but not here?
Or
Buy OTC Fluticasone Propionate spray bottles. Same just less potent so more sprays. Works out to about $25 a month cheap on Amazon.
Use GoodRx - cheapest is Walgreens at $187 per inhaler

So I want to start out by saying I will be speaking to my doctor as soon as the mycharts is back and running. Anyways I was given this information about my brain scan :Unchanged small cluster of subcortical and juxta cortical non enhancing cysts within the left frontal opercular region. There is mild surrounding FLAIR hyperintensity.tortuous left vertebral artery which indents left anterior aspect of medulla. I have recently been experiencing worsening fatigue, vertigo, and ringing in just my left ear. When I turn my head to the left my vertigo and migraine get worse. I want to know if it is possible for the brain abnormalities to cause this. I found these articles online pertaining to this and wonder if the abnormalities are causing these symptoms. I guess I can't attach said articles on this reddit but hopefully doctor have seen them. Any advice is appreciated. I already do PT, and OT and psychotherapy to "help" the conditions but have not had ANY improvement in conditions only worsening symptoms that are now debilitating and impending my ability to live independently. I am 250lbs, female, 28. I have endometriosis, pcos,fibromyalgia/ chronic fatigue syndrome, asthma, lichen sclerosus, insulin resistant, anxiety, ptsd, depression, adhd, ibs, stress seizures(PNES), migraines, vertigo, functional neuromotor disorderand brain cysts on my lower left brain. I'm also lactose intolerant, allergic to lavendar, eggplant, mushrooms, many trees, grasses, chlorahexazine wash, and -cillin based drugs such as penacillin and amoxocillin. I have had 3 excision lap surgeries for the endometriosis and then just had a full hysterectomy for it in November 2022. Med list: metFORMIN 500 mg tablet once daily methylphenidate CD 30 MG CR capsule once daily cetirizine 10 mg tablet once daily budesonide-formoteroL 160-4.5 mcg/actuation inhaler twice daily estradioL 1mg once daily in morning nabumetone 500 mg tablet twice daily pregabalin 150 mg capsule twice daily methocarbamoL 500 mg tablet once daily at bedtime montelukast 10 mg tablet once daily at bedtime desvenlafaxine 25mg 24hr tablet once daily NUCALA 100 mg/mL syringe once a month prazosin 2 mg capsule once daily at bedtime Benadryl once daily at bedtime As needed As needed meds: albuterol 90 mcg/actuation inhaler fluticasone propionate 50 mcg /actuation nasal spray. I am currently weaning off of prestiq and was instructed to cold turkey stop Buspar to get on different Psych meds. My symptoms started 3 months ago and the med change I'm on day 4 of tapering off. I don't know that any of that is relevant but it was worth mentioning. I also had some weird blood test results: low dhea-s, low vitamin d, elevated ths but upon fasting test was back to normal level. Blood tests also showed WBC at 13.7 has been flagged as high every test for the last 4yrs, hemocrit 47.1, RDW-SD 45.2 has been flagged as high every test for 4yrs, segs absolute has been high every test for 4yrs- last reading was at 8.4. I have severe brain fog and my legs will randomly go numb as well as the migraines and vertigo. Any ideas are appriciated. For background I do daily PT, and eat a plant based diet and I only smoke or eat cannabis concentrates and do not do anything else not prescribed to me. I also am very good about taking medications and doing pt and whatnot because I have alarms and apps reminding me to help with my memory issues. I don't know if that matters but I feel like I should give as much as possible.

First off I wanna thank this community for educating me so much. Things are making more sense and I’m better understanding my case.
My (25m) nasal aperture is around 23.3mm at the widest point despite having an IMW of around 31. I tried fluticasone, budesonide, ipratropium, azelastine, allergy shots, and daily saline nasal rinsing for around 5 weeks. Overall maybe a 5-10% improvement in congestion, no benefit in sleep. No nasal surgery done, slight deviated septum.
I reached the last vials in the buildup phase of allergy shots, haven’t experienced much improvement but who knows how I’ll be at the end.
I feel that the issue might be mostly soft tissue based considering my aperture size but also I may have measured incorrectly. PAP is difficult with this congestion, so my goal is to reduce nasal resistance and then get on PAP since my airway is also small (57mm2 minimum cross sectional airway). Basically I’m thinking if i can improve nasal breathing somehow and then test how I sleep with and without PAP, I can best determine where the problem is.
The question is how to improve nasal resistance. I’m hesitant to do a turbinate reduction due to what I’ve heard about relapse, not working, and ENS (although rare). Does nasomaxillary expansion make sense in a case like this? At first i thought yes, but my aperture width made me reconsider. Id probably do EASE but if more info on FME comes out that could change. Any help would be greatly appreciated!

I usually manage my crswnp with mometasone nasal spray and fluticasone drops.
Recently I have needed to rely more and more on the steroid drops. I take antihistamine and montelukast too even though I have no allergies they help somewhat in preventing the sneezing.
If I don’t medicate enough and rely only on antihistamines I get like a discomfort/heavy feeling in the sinuses at the back which I find hard to tolerate, even though airflow is relitavely ok it can feel heavy/like stuffed with cotton wool (like breathing through a small straw)with a tingling sensation on and off through the day (a bit like prickly heat rash but in the nose).mWithin hours of using fluticasonedrops I feel better.
I was speaking to a woman who said that what I have sounds like a rebound effect. Apparantly the chemical benzalkonium chloride in mometasone /fluticase can cause it. She said that her gp switched her to budesonide spray as this doesn’t have it in and she felt better.
So this past week I have been doing a self trial. I am still taking antihistamine but am only using Budesonide spray to see if part of my issue is rebound. I am on day 4 and am having that discomfort described above again.
I don’t know whether to persevere through and see what happens or to just take my fluticasone drops. I’m not sure how valid what she said is about the rebound etc. My symptoms are probably all down to my underlying inflammation but just to be sure it’s not rebound I wanted to try a steroid without that chemical in

I've been on daily PPI/Fluticasone for about a year and a half and it has been working very well. I went to refill my Fluticasone and been running into all kinds of issues. My doctor wants to switch to Budesonide which I have never tried and I'm very nervous. Is Fluticasone or something comparable no longer an option for people?

Did you know there is a connection between oral health and asthma?
When you use an asthma inhaler that has corticosteroids [CORE-te-coh-STAIR-oids] in it, the medicine can stick to the inside of your mouth. When the medicine stays in your mouth, it may cause problems with your teeth, gums, tongue, and cheeks.
Using corticosteroid inhalers can lead to:

• Thrush – a fungal infection on your tongue or cheeks
• Dry mouth
• Gum irritation and swelling
• Cavities (dental caries)

Examples of inhalers that have corticosteroids include:

• Advair Diskus® and Wixela Inhub® (fluticasone/salmeterol)
• AirDuo® (fluticasone/salmeterol)
• ArmonAir™ Digihaler® (fluticasone propionate)
• ARNUITY® ELLIPTA® (fluticasone furoate)
• Asmanex® Twisthaler® (mometasone)
• Dulera® (mometasone/formoterol) HFA
• Fluticasone propionate (generic version of Flovent)
• Pulmicort® Flexhaler® (budesonide)
• QVAR® RediHaler™ (beclomethasone dipropionate)
• Symbicort® (budesonide/formoterol) HFA

​
https://community.aafa.org/blog/asthma-medicines-can-affect-your-oral-health

Background: - Gender: Male - Age: 36 - Height: 5’ 10” - Weight: 147 lbs - Don’t smoke, take any kind of drugs, and barely drink. - Duration of issue: 2018 - to date - Medical History / Medications — Propranolol / Lorazepam — as needed for anxiety. I take them maybe a handful of times a year to manage anxiety for public speaking which I have to do a handful times for work. — Fluticasone / Budesonide - As needed — Betamethasone - was prescribed for the eczema that i mention below. As needed
A couple of years ago (2018/19) routine bloodwork showed elevated levels of GGT and ALT. The first question I was asked was how much I drink - which is maybe 2-3 time a year…. My doctor then sent me for a myriad of tests - from a liver panel, to checking for some rare genetic disorders to getting this 3D scan of my liver (I forget what it was called) to checking for things like celiac disease. All these tests came back clear.
We discussed my diet and for the most part I eat fairly healthy non-processed food. Only thing that was “unnatural” was Coke Zero which I drank maybe 1-3 times a week. Doctor suggested to stop and re-check my levels as he thought it could be a response to aspartame. 6 months later blood test still showed elevated levels. At that point the doctor was out of ideas and said “maybe it's just your baseline” — an answer I wasn't happy with but couldn't do much about.
I recently had blood work done again - same thing. GGT is 184 u/L and ALT is 55 u/L.
I don't know if this is relevant - but the only other peculiar thing leading up to my first blood test was that I would occasionally get “eczema” on my abdomen area on the sides. This was something that never happened before. They did a biopsy (?) and tested it and confirmed it was nothing to worry about. Doc mentioned likely as an allergic response to something I'm eating? I’m have darker skin so
I feel like I haven't really been able to get answers these past 5 years. I’m hoping to get some advice for things to investigate that I can take back to my doctor.

Sponsored by the MamaBear Health Smartphone App. www.loonmd.com
Lifestyle Changes:

• Encourage regular physical activity suitable for the child’s age.
• Ensure the child is not exposed to secondhand smoke.

Dietary Adjustments:

• Provide a balanced diet rich in anti-inflammatory foods such as fruits, vegetables, and fish13.
• Limit the intake of processed and sugary foods13.

Medications:

• Inhaled corticosteroids are commonly used in children with asthma. They include fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), beclomethasone (Qvar RediHaler), ciclesonide (Alvesco, Omnaris) and mometasone (Asmanex HFA)1.
• Biologics that target type 2 inflammation pathways, such as Omalizumab (Xolair), Mepolizumab (Nucala), Reslizumab (Cinqair), Dupilumab (Dupixent), and Benralizumab (Fasenra), may also be used4. However, these are typically reserved for severe cases and are administered under the guidance of a healthcare provider4.

It’s important to consult with a healthcare provider for personalized advice based on the child’s specific health needs and conditions. They can provide guidance on the appropriate treatment regimen and monitor the child’s response to treatment. Please note that while these strategies can help manage inflammation, they may not completely eliminate it, especially in cases of chronic inflammation related to an underlying health condition.

I am newly diagnosed (September 2023) I am currently taking budesonide and fluticasone. Has anyone else experienced such a tightness in the throat that even talking feels strenuous? Sometimes I’ll be trying to talk and it feels like I have to try so hard. My other symptoms are trouble swallowing and mucus in the throat that never goes away. I am feeling very depressed about this disease as my symptoms affect my daily life and limits my ability as a mom. Looking for any advice or insight.

38M, chronic bronchitis with a night cough that nothing stops. Been Rx'd budesonide and fluticasone inhalers, acetaminophen with codeine, DXM. I have even taken morphine and various herbal remedies. I also have a nebulizer for inhaling saline, and that sort of helps but only for an hour or so. Nothing stops the dry hacking cough that keeps me awake all night. The cough comes at night when I'm sleeping, during the day it's manageable. This cough started in Oct 2023 after a cold virus. Then went through getting better and worse 3 times until now when it is absolutely at its worst. Chest x-ray is clear. Negative for COVID. I've never had a cough this persistent and non-responsive to meds in my adult life.
Please don't tell me to use honey, a humidifier, or halls cough drops. I need advanced suggestions. I'm wondering if I should just use antibiotics at this point, though I have no fever, sore throat, runny nose, swollen throat lymph nodes or nasal congestion. It's all bronchial. I have a Z-pack here and I just might take it because I don't know what else to do. This cough is ruining my life and I feel like I'm going to lose my mind.
I woke up tonight at 1am and coughed violently (no blood) until 4:30am. Very little sputum came up. PLEASE HELP.

GINA guidlines Step 1 mild intermittent Asthma Short acting Broncholitis x as per need
Step 2 mild persistant Asthma Short acting Bronchodilators + inhaled steroids (budesonide+fluticasone+beclomethasone) 200microgram
Step 3 moderate bronchial Asthma Curative + Preventive + protector 5 years above increased steroids to max 800microgram LABAs with steroids “SERETIDE” Leukotriene antagonists “montelukast and zafirlukast” LABA’s contraindicated in less than 5 years
Step 4 Oral steroids by (1mg/kg/day for 3 days) If given more than 7days then taper off steroids

My insurance declined fluticasone so I'm trying to get budesonide. Is it only available as a slurry from a compound pharmacy? Why can't it be a swallowed inhaler like the fluticasone? Is it just not the right dose? My doctor is only part time so getting responses isn't the quickest thing.

Wanted to share my story in case it helps anyone. For as long as I (M, 26) can remember, whenever I ate food, it has gotten lodged in my throat (right where the esophagus meets the stomach), and it is only after a giant gulp of water that it would go down. Forced me to eat super slow…always was made fun of by friends for being the slowest eater. Tbh I could have/and potentially would have just lived through it, but in February, I got Mono and my symptoms became much worse…probably because of the swelling from Mono but I literally was chugging water just to get the smallest bites down. Felt like it was time to address the issue. Took me months to see a GI (I live in NYC) and more months to put an upper endoscopy on the books but I finally did it last Tuesday. During the UE, the doctor dilated my esophagus because he couldn’t get through with the scope, and took biopsies to send to a lab. My eosinophil count was a 25 (to qualify as having EOE, I believe you have to be above a 15); however, as I understand it, EOE is viewed as “you have it or you don’t.” My doctor then offered me three options with a fourth if the first three don’t work: 1) take omeprazole before bfast and dinner (I had started taking it before bfast, and it did nothing) 2) empirical elimination diet 3) topical steroid (swallowed fluticasone or the budesonide slurry)
If those options don’t work, they were going to recommend dupixent (which is expensive I think).
Three days after my UE (Friday), I decided to cut gluten out of my diet to see what would happen. Saturday, THE NEXT DAY, my symptoms entirely went away. We’re talking one day, people. Im still taking the omeprazole…and I did have my esophagus dilated…but even after the dilation, I still had symptoms for the two days before going gluten free.
I started connected some dots and recalled a time when I had an allergic reaction to a beer called Allagash White years ago. My throat got so tight I couldn’t swallow food, even with water. I never drank the beer again, but recall wondering what could have caused my reaction. Also, never really could drink BudweiseBud Light because it hurt my throat so badly. I think these are all wheat beers! Alternatively, Corona (which I don’t think has a high gluten amount) has always been my favorite beer…I think that I subconsciously preferred the beers that wasn’t making me feel crappy (shocker!).
Anyways that’s really it. I think I’m going to just stop eating gluten. It’s been 6 days and hasn’t been that hard and it’s made me feel so much better. The overall process of eating is much more pleasant…i don’t need to drink any water to eat and I also don’t feel like I want to barf after. Feels to me like I found my culprit…apparently gluten and dairy are the two major causes. Hope this helps anyone out there, but I think the reality is a lot of people live there lives with this, never even knowing that EOE exists. We don’t get the same notoriety as celiacs…
(If I said anything wrong, please correct me in the comments. I’m not a doctor, just wanted to relay what worked for me.)

25, FtM (meaning I'm AFAB), 62 kg, 160cm. On testosterone coming up to 2 years. No atrophy according to gynaecologist. Had 3 UTIs in the last 2 years (04.22, 11.2022, and now).
Can not tolerate nitrofurantoin and pivmecillinam has also been a bit problematic.
Currently trying to medicate the UTI and get rid of it, first. Medicated for Asthma (budesonide, fluticasone + azelastine), ADHD (methylphenidate), Acne (topical clindamycin/benzoyl peroxide) on face.
Went to ER with pelvic pain and urgency, confirmed UTI and took cultures. ER doc was about to prescribe when their network went offline temporarily, was told to go home, prescription would be there in the morning.
I specifically let the doctor know that my pulmonologist had recommended specific safe medications only for UTIs, (nitrofurantoin worsened asthma previously), Ciprofloxacin and Amoxicillin/Clavulanic acid being safe to take. However, the prescriber was a different doctor in the ER and the info never reached him.
Asked for second opinion privately, was given Amoxicillin/Clavulanic acid 500mg 2x per day, every 12h, 2 days later, so treatment was a little late.
Been taking it for 4 days now, 5th day tomorrow. Cultures came back, it's E. Coli and it's only sensitive to the amoxicillin/clavulanic acid in "larger concentrations". I had another consult with a private doctor, she said that's fine but to contact GP if the symptoms are even a little bit still there after finishing the course, and that they should do another urine test.
The worst of the pain is gone, it doesn't burn anymore, or hurt the back at night, but I still have some low-grade pelvic pain and urgency. I let my GP know that symptoms have not left completely through the messaging system, this morning, like they said I should too, and was told "the doctor has been informed", but I only had 5 days worth of antibiotics given. Tomorrow is my final day, and my GP has not given an appointment.
I also can't go to the private doc again, because the insurance won't pay for a third consult for some reason, and so no one is going to prescribe or do a new test tomorrow.
Is it fine if there is a pause in the antibiotics before being re-prescribed? Is it important that it be continuous?