3 April 2020
Supply of Inhalers
Yesterday we introduced you to Andrew Booth, an experienced Respiratory Nurse Specialist working in a GP practice. In part 1 of his blog he shared his ‘RESPIRATORY SUPER-USEFUL LINKS’.
Today’s post is about the supply of inhalers; an issue Andrew is dealing with on a daily basis. He discusses the difficulty when people request inhalers but haven’t had one for some time. In a worrying development some pharmacies have run out of certain brands of inhaler, possibly due to ‘panic-requesting’. Andrew outlines a useful back-up plan until the situation is resolved.
We’d love to hear your thoughts, and any tips you’d like to share. You can email us on firstname.lastname@example.org, or just post on our Facebook page. We’ll be featuring more from Andrew but you can also follow him on Twitter: @AODBooth
SUPPLY OF INHALERS
You may have experienced an increase in people calling for inhalers, who perhaps haven’t had one for some time. This can be rather tricky, as it’s vital to ensure people with asthma and COPD get the appropriate inhaled medicines at the right time. And it’s also important that we consider very carefully how we respond when a patient asks for an inhaler “just in case” I get symptoms.
One patient called asking for inhalers, as he was worried that his symptoms might come back because of Coronavirus. He was very well, with no cough, dyspnoea, chest tightness, night waking, and normal exercise tolerance. And no, he didn’t have a fever either. His last prescription for inhaled therapy was 24 years ago.
I acknowledged his concerns and advised that we would always treat any symptoms that he had. I invited him to call the surgery if his symptoms returned, when we would be pleased to assess his condition and offer the most appropriate treatment.
Our local pharmacy has run dry of some brands of inhalers, presumably due to pandemic panic-requesting (pandemic pandemonium). I overheard one rather glib comment that “inhalers have become the toilet rolls of medicines.”
This does raise a very serious concern that some inhaled therapies might not be available for people with asthma when they are most needed. Two brands that appear to be affected in my area are Clenil MDI and Fostair MDI. The manufactures have released a statement concerning Clenil advising “This is not a Coronavirus related supply issue but is linked to increased demand.” They have also requested: “We are asking HCPs to help us to maintain supply by not writing prescriptions for multiple months supply of inhalers.” This seems very reasonable under the circumstances.
In the short term, it might be useful to have a back-up plan in case the inhaler supply chain runs out of puff.
As Clenil is licensed for young children, it may be worth conserving limited supplies for them. Qvar could be a possible substitute, but remember to half the dose, and that it is licensed from 12 years upwards. Other alternatives include switching to Dry Powder Inhalers, which is no bad thing. Budesonide Easyhaler 100mcg and 200mcg are licensed from 6 years old. Budesonide (Pulmicort) Turbohaler 100mcg and 200mcg are licensed from 5 years.
A simple replacement for Fostair MDI 100/6 and 200/6 is the Dry Powder Inhaler Fostair Nexthaler, which is an excellent device. If the patient simply must have an MDI, then suitable licensed alternatives would be either good old fashioned Seretide (or one of the many generics), or the newer Flutiform, which is available in an MDI and a breath-activated MDI (the K-haler).
Hopefully, normal service will be resumed as soon as possible.