Really want to know how many ventolin inhalers you are prescribed a month as my GP has text me to say I need an asthma review as FOR NOW HE WILL PRESCRIBE THIS MONTHS, but in other words wants proof? I AM SO FED UP OF DRS..
So now need an M.o.t not long had one though whats the point if they want to stop a monthly one. Plus its freezing and taking this off me is not a great idea, also causing me more stress my heart races but i think its stress. (heart is fine)
It never ends with doctors sorry if your a dr but i cannot keep being bribed to go and have silly tests that ive had done months before with hospitals etc..
Yet if i cannot do feno all hell brakes lose with the hospital chest cons.. i mean really?
rant over. thanks in advance for listening.
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Shezxx
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I have asthma with poor control. Next stage for me if the current doctor plan fails is a referral for biologics.
I can have a ventolin inhaler once every three months, but every now and again they just give me another one.
A ventolin inhaler has 200 doses.
When my asthma is properly out of control I am on eight doses or so a day, but when I am like that it normally spirals and I end up in a and e for the day.
When I am in control, as I am now it is more like 10 a week, as I normally have one significant flare a week, where my peak flow is below 50 per cent. At that stage I use a lot of ventolin.
So for me one inhaler a month seems excessive.
So I would be hoping your consultant can do a proper review and come up with a plan to get your asthma more under control.
If the consultant cannot get your asthma under control maybe it is time for you to be referred elsewhere.
I’m prescribed 2 ventolin inhalers a month with prn atrvent & salbutamol nebulisers. Get a consult with respiratory, get a medication action plan and get the consultant to write to your GP and tell them what you need each month. Once you’ve been referred to consultants they should be the ones deciding on the medication regime not the general practitioner.
To let you know I go through four ventalin per month, taking it every couple of hours.. I also take fostair twice a day & seabreeze once a day.. hope this helps.. xx
I can just order them when I need them. Always have a new one so I never run out I also have a supply for my nebuliser. I have never been questioned about ordering them. I probably have a review about every 3 months with the respiratory nurse. After I have has a bad flare up she likes to review things.
I get one Ventolin (now Salamol) every 6 months, as there are a lot of doses in one. But then my asthma is not in poor control at present. When I have had an issue that requires extra stuff like antibiotics and/or steroids I have been prescribed two more.
I think this is a case of your doctor being a bit heavy handed, I get messages like this and it's just to get you in for a review, even though you may have seen a doctor recently. There must be targets or some sort of payment for carrying out asthma reviews, but once you have done it prescriptions will go back to normal.
As to how many ventolin I use, I can get up to 1 a month on repeat but my asthma is pretty well controlled with Fostair 200/6 and montelucast so I might only use 3/4 a year
yeah but now i have booked it will make me worse come to the asthma gp review i dont get the point, they want to give it me or dont then. there crazy with their threats
you should have an annual asthma check at the minimum - my peak flow was a bit down at my last one and I was recalled a month later. It’s good they are aware of the need to keep an eye out for deteriorating health. A ventolin inhaler has 200 puffs and in a normal week period it allows 50 puffs a week or 7 a day!!! If dominoes asthma requires that level of ventolin they need extra checks especially if they have been prescribed 2 or 3 good preventative meds.
Sorry that you are having a stressful time. I think everyone sharing their experience will help. I use one ventolin container a year. I thought that was normal until I read others responses. As I understand it, if you need ventolin (a puff) more than 2 or 3 times a week, your asthma is not controlled. I think the fact that your GP wants to see you shows that they are a good practice as they want to properly monitor your care. Poorly controlled asthma does put you at greater risk if you get illnesses so it's really worth working with your GP to find out what's going on there. Since being diagnosed myself in 2018, I have removed as many triggers from my life and home and found this a great help with asthma control. I wonder if there are asthma triggers in your life? Your mention of anxiety made me think instantly of the ventolin because it can cause those feelings because it speeds up the heart rate. I wish you all the best with your care and please know that it's normal for GPs to want to see you if you're using a lot of ventolin.
I think it's probably to do with doctors making cut backs.
Our GP practice is usually really good, but when I ordered my support stockings which is every THREE months I was told I have to wait until August which is NINE months! NICE and NHS guidlines are 3-6 months. I feel a complaint letter is brewing.
Sorry, I went off topic, I hope the asthma review goes well so you can keep on ordering your monthly Ventolin. It's very worrying when you're cut off from something so important. Hugs x
As a doctor with a special interest in asthma, I was really concerned to read these posts. The reason why doctors are focussed on the short acting relievers like Ventolin which is also called salbutamol is that these drugs do not treat the underlying inflammation due to asthma. Secondly regular use of these relievers without a preventer ( inhaled corticosteroid) is potentially dangerous because they can worsen asthma control and in people using more than one a month, they have been associated with asthma deaths.
If someone needs more than four puffs of salbutamol a week, their asthma is considered to be out of control. So if you do the maths - there are 200 puffs / doses in a ventolin inhaler- so if your asthma is well controlled you should not need more than four puffs a week or 1 inhaler a year. So from recent research confirming that people prescribed more than two salbutamol inhalers ( with 200 doses) have greater risk of ending up in hospital with an attack doctors are being urged to be more vigilant in trying to optimise care by adjusting preventer medication.
So in my view, your doctors are really quite rightly concerned for your safety when they ask you to attend for a check up if you are using more tan three reliever inhalers a year.
If anyone needs more persuasion read the U.K. National review of asthma deaths (NRAD) published in 2014. (Search for NRAD and RCP- to find the report called ‘Why Asthma Still Kills’
I read the NRAD review several years ago and appreciate its contents.. which make perfect sense.
I think the problem is really the lack of continuity of asthma care between not only individual GPS but regions and even the NHS as a whole. There seems to be no joined up thinking .. despite good guidelines and reviews as above.??
When I hit tertiary care for my asthma, my GP practice (which at the time was generally pretty good) just seemed to switch off from my care or really any responsibility for it and I soon learned to look after myself!
This scenario is ok if you are then allowed to be responsible ( and are given the correct training) to look after your own care..
Since then I must admit to being very switched off with my GP practice - so I would feel the same as Shezxx if they were to refuse me the medication that I knew I required.
What I think I’m trying to say is that GPS cannot just cut you adrift to manage alone but then wade in when it suits them financially or to ‘ tick their boxes’ for targets.
I don’t have any problems obtaining salbutamol either nebs or inhalers from my surgery anymore… for the reasons quoted above.
Shezzx - I hope you are able to get this sorted.
Def agree… talk to your hospital team and get them to instruct your GP.
I'm in a similar position with my GP and agree with you Pipsqueak. I absolutely appreciate the reasoning behind keeping an eye on Ventolin use, but it needs to be situation dependent. So far mine have been ok, but I wouldn't be impressed if they did wade in and try to ration use when they should know, if they take a moment to check, that I can't optimise my preventers any more.
On principle I do like it when someone new notices and raises it with me, as long as they accept my explanation and don't try to fit me in a 'brown and blue' box. I would like to think they don't leave more typical asthmatics mainlining Ventolin when they really do need a review and could have a better preventer regime! So far they have seemed satisfied when I explain the situation.
The tertiary centre I go to is to be honest just as unhelpful as the GP - actually probably even more unhelpful, because I can appreciate the GPs feel a bit lost with me. I agree that there is a lack of joined up thinking as the hospital often tells them nothing, or just sends letters which don't reflect what was actually discussed. (I had a nurse review in October at the hospital. I was told there would be a letter. There has not been and if there were I know it would have just said everything was fine and nothing about what I said or my spirometry etc, which was less fine than I expected it to be).
I realise that to a large extent they can't really do anything, but like you've said I find it annoying when my approach to management is criticised by someone who isn't actually helping me to find something that works better. I'm happy to listen and discuss, but it has to be more than 'don't do that' without a viable alternative.
I agree with you re gp switch off. My gp asthma nurse was never keen in looking after me as she said my asthma was too out of control, but did me an asthma plan, got me on fostair etc. Then from when I was referred to hospital, I was just told when I rang the gp practice that, no asthma nurse was available.
I assumed that the gp surgery had no asthma nurse, however come my annual review, the asthma nurse resurfaced, told me my condition was life threatening and basically why was I not more worried, then immediately became unavailable again.
Then the gp practice sent an email to all patients saying that they no longer expected to be involved when it was something that the hospital should be doing. They were complaining that the hospital passed things onto the gp when they should not.
So my gp practice basically thinks I am the hospitals responsibility, the hospital though works on the basis that the gp does basic care, such as prescriptions, dealing with flare ups. The hospital even calls its Asthma nurses, spirometry nurses, to accentuate that they are there to do spirometry tests, rather than to provide care. So you fall between the hospital and the gp.
I could handle this if allowed to have rescue steroids and a nebuliser so I could handle flare ups, but I am not allowed to have these, as they might hide the true severity of my condition.
I agree with you that the care you receive is dependant on where you live. Everything I have learned about asthma is from my own reading. I realised early on that if I wanted to get control and reduce the potential of serious issues, I was going to have to take charge myself. Not everyone has that ability though so I think much more support is needed, or at least should be offered. I don't think people should have to spend ages researching info and advice that should be freely given.
Correlation does not mean causality. The use of ventilators is also correlated with covid deaths b.c. people who died of covid often did so while being on a ventilator. This does not suggest that ventilators cause covid deaths. By refusing the rescue inhaler prescriptions, while offering no alternatives to control asthma (i.e. offering no biologicals) the GPs cause more harm than help.
I agree that correlation doesn't equal causation. I also agree that just restricting Ventolin without considering the reasons why people use more isn't a great idea.
As various people have said, sometimes you can be on everything and still need it. (Though GPs of course can't make decisions on biologics, and some of us sadly aren't eligible for current ones!)
But also, Ventolin use can be a reliable indication of poorly controlled asthma in people who are really dangerously poorly controlled. I am not in favour of GPs just restricting Ventolin without thinking about the causes, because actually the idea is that it's a red flag for asthma control. If someone is getting through a lot of reliever, especially with a new increase, they need to be seen asap to work out why and to address the causes (not taking preventer? Poor inhaler technique because not taught how to use it? Needs a different preventer/an add-on?)
The danger with Ventolin can be that it's like a dressing or stitches for an infected wound that keeps reopening - it relieves symptoms/ 'closes the wound' temporarily, but it doesn't do anything to address the underlying cause. And there can come a point where it can't keep up and it stops working - which is also the reason why home nebulisers need to be used sensibly and not necessarily for everyone.
(By the way, I get what you were trying to say with the ventilators, but I believe they were found to actually be harmful to some patients with COVID because of the disease and what it was doing to the lungs. Once they worked that out and tried to reduce ventilator use/try other things first as much as possible - while obviously still using them if they had to - they got better results and I think it did reduce mortality to some extent.)
Of course I agree that correlation and association doesn’t mean causal - however as a number of people have said, ventolin ( salbutamol) doesn’t treat the underlying asthma. The idea of asthma treatment is to control the inflammation and prevent flare ups/ attacks.
So I wanted to emphasise the dangers of overrelying on these relievers.
While some people may be uncontrolled even on biologics- my point is tgat if you need to use excess salbutamol ie more than three (200 dose) inhalers a year, you should be insisting on seeing someone with asthma expertise- most GP practices do NOT have a properly trained asthma nurse and my suggestions are:
I) ask whether here is a diploma trained nurse or a GP with asthma expertise in tge practice- and if not and your asthma is troubling you/ your child - then ask for a referral to a specialist.
II) If you are on high dose treatment or on three or more asthma drugs ( count the combinations like Fostair or Symbicort as 2; and don’t count ventolin/ salbutamol) or had 2 or more admissions or A&E attendances - then ask to be referred to the nearest severe asthma clinic -
Quote tge BTS/Sign Guidelines & NRAD if anyone refuses to refer you. Asthma can generally be mannaged by GPs however from many of your stories in this thread, specialist ( asthma expert) advice and help is required.
Hi yeah i understand that but i get told that many different things i have apart from my history, i know what helps me is what i mean but i get there is cut backs and targets etc but it makes me worse when they threaten me, i am a nervous wreck. i have complex chest history as prob most people with asthma do have anyway, its the constantly keep proving my chest i get angry at esp hosp chest cons.
It’s great you’ve joined the site & can explain things from a GP perspective. Your patients are very lucky & I’m so pleased to see you’re involved in teaching too 👍
I’m atypical in that my asthma is uncontrolled even on max meds & biologic injections. I have a great team looking after me at the Brompton. Where I come unstuck is when I need fast, local care. My GP is more or less uncontactable since the pandemic struck. There are too many patients for the surgery to cope with. Twice I’ve managed to get through (in 3 years!) & been told to go to A&E. All they do there is stick me on a nebuliser, which I’ve got at home anyway, and chuck me out once they’ve decided I’m not going to die on them! So, whilst I recognise GPs’ problems, the fact is that severe, uncontrolled asthmatics like me feel very abandoned by the NHS & just have to medicate ourselves as best we can 🤷♀️
I’m sorry to read this. Your asthma sounds too complicated for a GP practice to deal with. Have the Brompton doctors informed tge paractice how severe your asthma is? And more importantly, have you been provided with a person ( eg respiratory nurse) to contact at the Brompton when you need urgent advice? In my view someone like you should be provided with ‘fast track’ access to specialists as well as local A& E and tge GP. Suggest discuss with the Brompton and request they provide you with a letter to your GP as well as one to show at A&E if you need to go there for uncontrolled asthma.
There used to be a system like that in the past at Edinburgh Hospital - I havnt heard of this system being in place anywhere else , however in my view this should be discussed. Perhaps the Lung and Asthma Society could mount a campaign on behalf of people with asthma to ensure fast track access for people with severe asthma?
i do have 3 inhalers, ventoli, sprivia, fostair nxhaler but my point is my hosp cons should communicate to gp as ive had a million and one f2f reviews yet gp wants another review? I understand but then all i get is completely different opinions of doctors who do not know my complex chest history, some google???????? yes google it in front of me. I know some doctors are great I am just saying can they not all communicate. they soon do to say I have done something wrong. I am just fed up with the constant battle just gets me down trying to keep proving all the time I have weird bugs or asthma or whatever illness. I may not even go back just so stressful they can stick it. I just want a doctor to listen and not google it or read what last weeks doctor has said. The i get a letter saying something i have not said so i just think what is it about the drugs i am on. 1 ventolin a month. i mean is that really braking a budget or something i really need, had this since i was a child so now they want to keep messing me about and take it off me? but it is interesting from a doctors point of view but not mine i feel very judged half of the time with some drs, hopefully i will sort it if not i will end up in A&E again if they take it off me assuming i can cope without it for 2mths.
I was under the impression that preventor inhalers were not high dose steroids? Are you able to do any weight-bearing exercises? That's good for the bones and the muscles to support the bones.
yes I play tennis 4/5 times a week. I developed osteoporosis due primarily to an 18 month course of oral steroids and the latest research indicates inhaled steroids contribute to bone thinning too (though nowhere near as much). It’s a balancing act!
I use one per month. I have big lungs and when I exercise I need 10 puffs. Thus, if one exercises 3-4 times a week, the 200 puffs go quickly. They keep asking for reviews, so I go through them. This is annoying, but it's better than asthma. Also, I bet AE can help, like they help me with preds when the GP is being difficult.
there are 2 types of inhaler I have had over the last 3 year , I was using ventolin ( which is the best ) and I was given this tony in haler ( which is better for the environment) I went through 4 of them in a month were 2 ventolin last me 6-8 weeks depends on what activities I’m doing as I try not to let asthma limit what I can do and I work in a waste management which has dust of all sorts which effects it
At the moment I order my meds. when I need them and my GP practice trusts me to do that. My previous GP( just retired) would give me two ventolin inhalers when I ordered them which isn't often at the moment as my asthma is pretty well controlled with my preventer inhalers. Sometimes I think it is very helpful to have two in date ones at a time so for instance you can keep one in your coat pocket and one in your bag as you may change your coat or bag but not usually both at once and, if one is running low you can have the fuller one with you in case the less full one runs out in an emergency.
I have also been told that this chest cons wants to drop my steroids way to quickly so will no doubt end up in hospital if goes ahead. my endos are good but never in. also heart is racing again, felt shocking in work but heart is fine. its weird feeling never had this before. feel heart is racing and had to sit down felt sick its a funny weird feeling anyway just wondered if any one has ever felt this way with their chest? any advice greatly recieved. even face went warm yeah really weird. if i wasnt in work today i would have gone to a walk in clinic but i will be sacked any more time off at my job so had a drink of water sat down for a min. hope your all ok. thank you.
Since Covid there seems to be too much micromanagement.I have had asthsma since I was 5 years old, I'm now in my 30's and all of a sudden I'm being told that I have bad asthma management. Like I can control my asthma to the extent I should be like a robot and program my body to do as an asthsma nurse commands.
How dare I get colds in winter where I need to use my reliever far more frequently. Funny thing is the asthma nurse told me it is ok and expected to use them more over winter yet probes me when I do. We are individuals but are treated like a machine where we are all suposed to have the same attacks at the same time and not more than 3 because so and so said so.
I have been 'allowed' to have one reliever per month for nearly 25 years but niw all ofca sudden I can only have 1 per 3 months and made to feel like a naughty child should I want more.
How utterly bizarre to force me to regular reviews under threat of witholding my medication just incase I order slightly too soon.
I am utterly convinced there is a mandated commissioned pay to have us killed off.
This is just control freakery, I just want to be left alone, have a review once a year and be done with it.
The reliever is a life saver and although doctors here in the messages claim they are merely bronchial dialators they only relieve but don't help the inflamation. What utter garbage excuses, the idea of them is to help for the purpose. If there is other conditions that cause asthma then why is there no treatment for it except bronchial dialators that do the job adequately. No ongoing 'inflamation', just relieve and it ends the attack. This is just "Karen" politics controlling people for an over zealous system.
We don't get our £2 reliever for free, it cost us nearly £10 so we are a fantastic source of profit.
It seems that when something works we are not allowed to have it.
The relievers work, always have, no ongoing issues and no one trying to dictate my lifestyle over and over with threats of medication removal if my body doesn't comply with protocol.
What if I jog or am triggered more or get a cold?, I'm suposed to jump through hoops and becthe good child for my reward but onky every 3 months and inbetween tough or half die over the back of the sofa until an ambulance comes.
Can't even have spares to keep at relatives house or work, no, just 1 that we have to remember and not lose or we could die and now it's being rationed. Be interesting to see how many deaths or hospitalisations occur because of rationing of life saving medication for the most vital element oxygen.
I don't want to be squeezed, proded, poked etc., for something I've had all my life and managed very well until now where control freakery has taken presedence.
Stress doesn't cover half of it, I'd rather die than continuously be forced into interferement and assessement like blackmail justvto get my medication all because of an anti dogooder!
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