Salbutamol prescription problems.

[Loulou9000]

Hello all - This is my first post, but have been lurking for awhile. I am having problems getting my Salbutamol repeat. I used to get two inhalers but this was flagged by pharmacist and I was called to an asthma review with Asthma nurse at my GP surgery. Unfortunately although part of this surgery most of life (56) now the staff have all changed in the last 18 months.

At review Asthma Nurse said I must go to consultant my asthma is not controlled despite me assuring her it is the most I’ve been controlled for years. She has insisted I see a consultant.

I have two types of symptom the one I get with colds and infection. Really inflamed lungs, wheeze like an old steam train, slows me down, can be out of Acton for weeks, need steroids and antibiotics to get better. Three hospital admissions over 50 years 2 pneumonia and one Acute bronchitis the later 3yrs ago. Not had a real serious attack since then.

The other symptom is daily I’m well normal then bam, I hit a trigger and suddenly can’t breath, much slighter but tighter wheeze take salbutamol and it is reversed mostly in about two minutes, sometimes half an hour. Then I am fine again.

I have explained this to 3 GPs now who agree I don’t need to see consultant and put me back on repeat for two Salbutamol and happy for me I’m controlled. But I keep getting flagged and have to go to nurse and go through the whole sequence again.

My questions sorry I know it’s long!🙁

Does anybody recognise these type of symptoms and do you use salbutamol daily? I would say I have 1 quick attack most days but can have several.

Two should I insist on seeing a consultant to stop this yo yoing between Pharmacist, nurse and GPS?I’ve been before and nobody has ever been able to prescribe anything that has prevented the short attacks but salbutamol reverses them well.

I feel I would be taking up resources for people who are really out of control and struggling.

Sorry for such a long first post but every time it’s time for repeat I feel I’m on ground hog day.

[HungryHufflepuff]

Do you not have any inhaler other than the salbutamol? I have no expertise or medical knowledge at all, but it would seem you ought to have something other than just Ventolin 🤔

[Loulou9000 in reply to HungryHufflepuff]

Hi HungryHufflepuff thank you for your reply! Yes sorry in my attempt to keep it short I forgot to say I take seretide 500 Accuhaler twice a day.

[HungryHufflepuff in reply to Loulou9000]

Thanks for clarifying. It must be a frustrating situation to find yourself in. Definitely Groundhog Day! (I too have Seretide but it’s the 125 inhaler)

[EmmaF91 Community Ambassador]

Hi

The reason you keep getting flagged is that national guidelines say that if you’re using more than 6 puffs (3 doses) of salbutamol a week then you are uncontrolled, so using 2 inhalers up a month isn’t a good sign to the pharmacy. From the sounds of it you may have a permanent underlying level of inflammation hence why you’re triggering most days. Whilst generally you feel fine, this underlying inflammation can cause big issues (statistics say often it’s the more mild asthmatics that die from attacks cause they don’t think they’re that bad, but over time you can become ‘immune’ to salbutamol and they you have to go to hosp which they don’t). Good prevention therapy should stop this underlying inflammation/reactivity/twitchiness happening.

If you’re already on the ‘max’ prevention therapy the GP can give you (preventer/add ons/additional meds like antihistamines etc) then it’s probably worth asking for a referral to a hosp consultant if that’s what they want to do. Asthma guidelines have changed a lot over the years, and they no longer prescribe ventolin as prevention therapy (they used too so ‘old school’ docs/long term asthmatics often are prescribed it).

I do use salbutamol basically daily but I’m under a specialist consultant, and on the maximum asthma therapy (including injections) so the pharmacy don’t flag me as my prescription list shows how uncontrolled my asthma is (I have prn salbutamol nebules for example).

I hope that helps xx

[Loulou9000 in reply to EmmaF91]

Hi Emma thank you for your reply yes I’m aware of the guidelines so this is what is flagging me up. However I have been under consultants before who are aware of my medication because this has been the same which was prescribed and I was discharged from them 15 years ago. I am Much better than ever before, back then I was classed as severe and struggled a lot.

Problem is Nurse can’t refer by GPs who need to refer say no need to see consultant but of course every month I get flagged. I really am not that ill as long as I take the medication which works. I work full time so having to see nurse to then see a Dr ( never can see on same day) who then says I’m fine is difficult it’s been going on for about six months now.

Just wanted to know really if I am so unusual to warrant this attention.

[Chip_y2kuk]

You shouldn't need 2 inhalers a month and if you are I would agree you need a change in therapy/something else doing

Do you have a combination inhaler?

[Loulou9000 in reply to Chip_y2kuk]

Hi Chip_y2uk thank you for your reply. It’s getting GPs to agree to refer to consultant that’s the problem. They don’t seem to have concern, I am well documented and in regular contact with them for mild outbreaks with cold etc. It is tempting to insist to go to see if I could benefit from new treatment but also don’t want to waken the asthma dragon within where getting it under control with medication took a good decade under consultants.

[Chip_y2kuk in reply to Loulou9000]

I know what you mean but theres loads of things you can try (and I dont know but you may have)

Tioptropium (braltus/spiriva brand names)

Combination inhalers which are a steroid and a longer lasting version of salbutamol (formoterol or salmeterol)

Montelukast/seretide

May be worth an experiment If you've not tried these

[Vee70]

Crikey i’m glad i read all these posts, i have been using my inhaler at least 4-5 times a day with increased breathlessness. I put it down to the high humidity but luckily have a gp appt on Mon

Think i may need to try something else 😳

[Loulou9000]

Thank you everybody your input has been really useful I really appreciate it. I think I’ll make a telephone appointment and speak to GP I spoke to last week and ask him to put a referral in. I believe if there should be a change in medication I would prefer Asthma specialist to oversee it just in case. I understand better what the nurse was trying to say when she said not controlled. I had thoughts of when I was really out of control, but maybe with newer medications available it may be able to control it even better. I’ll let you know how I get on but it will probably be a bit of a wait.

[Vee70 in reply to Loulou9000]

Good luck x

[Birthday60]

I would go to see a consultant as your asthma nurse has quite rightly identified you are not controlling your asthma you are simply treating the symptoms. There are a number of really excellent preventative inhalers and tablets which I would strongly recommend you give a try. I am 61 and have had similar asthma you are experiencing for 60 years allergic, stress, exercise and chest infection types. I was using 2 salbutamol a month but now only take a puff before vigorous exercise or come across a long haired dog/cat unexpectedly. When I last saw a consultant had a lung scan, X-ray, loads of different capacity and performance lung tests and was very pleased with the outcome. Why would you want to be tied to your inhaler and not want to get the best treatment possible to lead an active and attack free life? Give a try- you’ve nothing to lose and so much to gain

[Loulou9000 in reply to Birthday60]

Thank you Birthday60 for such an inspiring post. Yes I will go, just need a GP to agree to put in a referral .

[Trimley]

All I can is you are lucky these days if you can get to see a consultant. I've been waiting for 8 months!

[Loulou9000 in reply to Trimley]

Yes you are right Trimley it is frustrating how long the wait is. I am great full I am still functioning, I haven’t even got the referral yet! But I’m anticipating it’s gonna be awhile, but I should push to get the ball at least rolling. I hope you get your appointment soon!