I’ve read a number of comments on this site concerning the move from Ventolin to Salamol inhalers. People are concerned that the Salamol inhaler is much weaker, therefore needing more puffs than the ventolin equivalent and I have also read about the bad taste of Salamol inhalers. It seems that Salamol is the NHS choice of reliever inhaler - the reason being given is that it is better for the climate. I’ve just checked and both Ventolin and Salamol have exactly the same propellant : HFA 134a which is cfc free. Therefore the climate argument lacks credibility. So why are people being moved from a more effective, well received inhaler to one that seems to be inferior in many ways - causing a lot of distress and anxiety? Anyone got any idea?
Ventolin versus Salamol reliever inha... - Asthma Community ...
Ventolin versus Salamol reliever inhalers
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As I understand it Ventolin is a trade name of the drug Salamol but the generic latter contains lesser propellant so is considered less pollutant. They are the same drug but presented in a different form. I went back to Ventolin as seemed to work better but perhaps that was just from the nature of delivery. I was then given a spacer coz I can't hold my breath for long enough (30 secs) as advised for usage of same. Maybe generic version tastes different as more condensed re less propellent?
There is more alcohol in Salamol - in the form of ethanol - than there is in the Ventolin Evohaler, though I believe there is some form of alcohol in that too.
Salami is generally cheaper and has less propellant, therefore smaller carbon footprint.
But there is no cfc - carbon - in either Ventolin evohaler or salamol’s propellant. The propellant is the same in both - HFA 134a - and is carbon free.
Propellants contain hydrofluorocarbons, by using less propellant salamol reduces the carbon per metered dose from from 28 to 11.
There is no cfc in either propellant - Salamol or the Ventolin Evohaler - which has been specifically designed to do away with the carbon, so that’s not a reason to swap them. Some people need to use far more of the Salamol though it seems that some people prefer it. I haven’t tried it yet but it’s been swapped on my repeat prescription.
I must admit that I have never really understood the push to move people onto cfc free inhalers. I can see that some people get on with them fine, which is fine, but I also recognise that some (including me) don’t. They tell me it is the patients choice, but I think that is a back door way of forcing this on people. For example - my prescription came yesterday- prescription states Fostair, but it contained Luforbec, so I rang the pharmacist. Of course I was told they were both the same, but when I said that the Luforbec was not as effective for me I was told they would send me out a Fostair.
Now, this irks me because it has taken me ages to get good control of my asthma. I don’t go on long car journeys, I don’t fly frequently, I have big gardens with lots of trees , shrubs ,plants and weeds. So I reckon my carbon footprint is quite small.
I also don’t see how substituting inhalers can really do a great deal when countries like China, India, Vietnam etc have such high pollution. Poland, with its coal fired industries. Get the big polluters under control and then look at the rest - leaving medications until last.
However, there is room for improvement in that we could be provided with the canisters and reuse the device. This would surely reduce the amount of carbon used in their production and destruction. A counter on the reliever inhalers would be useful. This might reduce wastage- I read a study somewhere where blue inhalers were being discarded while there were still doses left in them.
I think there needs to be a bit more creative thinking.
I totally agree with all that you say.
I totally agree Troilus, such a waste of plastic. Just supply us with the refills please pharmacists. My chemist doesn't recycle, I gave to save mine up and drive, yes drive my petrol car to the recycling centre several miles away to deposit the canisters in the hard plastics and the aerosols in the correct receptacle 🤬
I agree the canister could be supplied separately and reuse the device in fostair and Ventolin salamol and fostair. I Think that every time I dispose of used med casing. I have been moved onto salamol I am finding I take more but I thought it was High pollen due to rewilding gone a bit mad with rewilding local to me grass and weeds have been huge can not avoid it. Also I used to be on Braltus that had reusable casing now on EkliraGenuair Achlidiniumbromid metred dose throw away casing.
Hi
Agree with others…
Basically - cost! 😜 Maybe lower carbon/ozone depleting footprint?? But this is all pointless as I now use twice as much because it’s half as effective!! 🙄😂
So what’s all that about??
😊👍
There is no carbon in the propellant of either inhaler.
The propellants use hydrofluorocarbons rather than cfcs. As hydrofluorocarbons are not so bad for the ozone layer. Hydrofluorocarbons obviously contain carbon.
Hydro fluoride alkanes - alkanes are of course organic carbons but this mixture is deemed less damaging to the environment ( are they water soluble?) than chloro fluoro carbons that are apparently indestructible and 10000 times worse thanCO2. The point is that both ventolin evo and salamol have the same HFA propellant.
Salamol uses less propellant per dose than ventolin which is why it has a lower carbon footprint.
It is also probably why some people find it less effective.
The salamol inhaler is half the price I am unfortunately on several medicines and lots of been changed to cheaper versions I am now on combisal inhaler which I used to be on sirdupla its all for financial reasons I did speak to my gp regarding salamol because I struggled to breath and shale the inhaler to get the medication to work I ended up in hospital due to not being able to take reliever correctly now I have salbutamol nebules
There is definitely a massive difference in strength and also where ilive we are limited to 4 salamol inhalers a year and was told if you needed more than that you need to be better controlled I feel that is also an issue but I respect the nhs
Being in dire straights right now xxx
4 a year does not sound right call an asthma Nurse Or British Lung Foundation for advice If that is the case I would bet there is a high hospitals admissions in your Postcode area.
The salamol inhaler is half the price I am unfortunately on several medicines and lots of been changed to cheaper versions I am now on combisal inhaler which I used to be on sirdupla its all for financial reasons I did speak to my gp regarding salamol because I struggled to breath and shale the inhaler to get the medication to work I ended up in hospital due to not being able to take reliever correctly now I have salbutamol nebules
There is definitely a massive difference in strength and also where ilive we are limited to 4 salamol inhalers a year and was told if you needed more than that you need to be better controlled I feel that is also an issue but I respect the nhs
Being in dire straights right now xxx
So sorry to hear of your difficulties. It does seem that even if it is half the price of Ventolin, it is a false economy if it causes problems such as those you have experienced. Many people describe similar difficulties in using the Salamol inhaler from it being a weaker strength and thus ineffective, problems with holding and using it and the fact that it clogs up after a short while and doesn’t deliver until it’s cleaned out - it strikes me that it is a sub standard and dangerously ineffective replacement for a relief medication asthmatics rely on. Ineffective to the point of causing hospitalisation at times. I wonder if someone involved in selecting this cheap substitute has done any research either before or since implementing the policy. The company producing Salamol stands to make a fortune out of the decision to make it the specified NHS relief inhaler - are any of the decision makers gaining financially too?
Very true not sure but I have 3 lung diseases and struggle a lot of the time So to change anything medicine based for me is bad but there was no consultation or advice from nhs it was done I tried and failed using it and my gp has agreed to continue with ventoline so I am ok now .but how long for its very difficult to be poorly as the nhs is at its knees but I do feel they could make some better choices and maybe it would help with the finances
I’m glad to hear that after a quite upsetting time you are now back on track and feeling better. I agree with you about the decision making and think it should be reviewed.
When your going through difficult time it is so hard I am so glad your feeling better and am really grateful to this site its helped me so much just hearing others talk openly about what helps them and what doesn't. The advice is priceless.
This reminds me of a similar situation some years ago where patients on a particular (and highly effective) preventer inhaler were switched to a cheaper generic version and were told it was exactly the same. It wasn’t- there was a difference in the propellant. The thing that was interesting was the number of different excuses being trotted out as a reason for the switch - which I admit I considered suspicious at the time. The real reason was, of course, cost. A number of patients whose asthma had been reasonably well controlled suddenly found that they were struggling and had to be changed back (but in at least one case it had to be specially requested - the GP couldn’t do it). The generic version was nothing like as effective; a change to the propellant can make quite a difference.
I’m due to have my annual asthma review today - it’ll be interesting to see if this comes up. Last year I had to defend my use of an accuhaler for ventolin (it’s more expensive). Accuhalers come with counting devices so it’s possible to see how much medication is left - not possible with evohalers (though I also have an evohaler + spacer device in case of a sudden, very severe attack or during a respiratory infection when using an accuhaler can be more difficult). I pointed out that I often wondered how many asthmatics ended up in A&E simply because their ventolin evohalers had run out without them realising it. That’s the problem with something which should only be taken on an as and when required basis when it’s impossible to tell by looking at it how much is left. I finished up by telling her that perhaps she (and others pushing for changes to life saving medication on grounds of cost) needed to ask themselves how much is a life worth before forcing such changes on patients.
I was allowed to keep my accuhalers:-).
Well done! Good for you!
>>> I pointed out that I often wondered how many asthmatics ended up in A&E simply because their ventolin evohalers had run out without them realising it.
I have a manual counter attached to my inhaler. It states 200 puffs, so I stop using it at around 150.
The annoying thing is we shouldn’t have to do that. My younger son (also asthmatic, now mild and intermittent but as a child rather worse than that) recently returned from the US having spent nine years out there. The ventolin evohaler he was issued with over there came with a counting device, so they do exist.
One never knows what a particular country will discontinue, or introduce, for whatever reason. Xolair is impossible to get in the UK based on prior history (until you end up in the hospital and have to take pred for a year), but in DE it was very easy. At the same time Ventolin is no longer available in Germany -- it's only the horrific generic described in the original post. Switzerland still has Ventolin, but I wonder if it's about to disappear, too.....
I know yours is an old post but interesting what you say about Xolair in Germany. Do you have much experience of this? My immunology consultant has told me he believes Omalizumab would totally change my life but respiratory will not prescribe. I'm taking instead inhaled and oral steroids along with multiple inhalers and antihistamines which are becoming less and less effective. I understand that Omalizumab is expensive but I'm in business and paying a lot of tax which must be better than being confined to my home and paying no tax, which is the way I'm heading.
On a recent business trip to Munich I was taken ill and got a doctors appointment within 30 minutes. I also had an asthma attack in Greece this summer and again had an appointment that day. In the good old UK I get a consultation with a receptionist. I was recently prescribed permanent Azithromycin by respiratory which I hate the idea of then discharged and told if I felt unwell to first try Gaviscon. I repeatedly told the registrar I do not get indigestion. Just another bloody way to send me round in a circle again.
As my business is 40% German sales I may look into moving it and my family there after researching Xolair. Totally fed up living in this tin pot little backward country.
I have had severe asthma for over 40 years and have real problems with Salamol inhalers. I changed my pharmacy from the one at my GP surgery to the local Boots Chemist as they have always issued Ventolin as a matter of course. However, the last repeat prescription they issued Salamol instead.
As a lot of people on the forum are saying it seems weaker and instead of taking two puffs I take 4 or maybe 6 puffs before I feel any effect. The speed the mist comes out is a lot slower than Ventolin making you feel you haven’t had a full dose. I also dislike the taste. As neither inhaler is metered, I usually give it a shake to hear how much liquid I can hear sloshing about, enabling me to work out how much I have left. Unfortunately, Salamol doesn’t make a sound, so I open up a new one just in case it’s about to run out,
A few years ago, I asked my GP if she could specify Ventolin on my prescriptions rather than Salbutamol and she said no - it cost the surgery more, which really embarrassed me.
I now order a Ventolin from an online pharmacy and it arrives by post. I keep that for when I’m very wheezy or going out.
Perhaps you should point out to this medic that as you’re having to take 3 or 4 times the dose to get any relief, in fact the Salamol is neither cheaper nor effective.
You have to wonder how long it will take them to realise that people are getting through their relievers more quickly and so perhaps it wasn’t such a good idea. But I suspect they will then say that asthma control in the nation as a whole has obviously taken a downward trend because sufferers are needing to take more of their relievers, etc etc etc, at which point they might look to change preventers. I rather suspect that improved preventer medication is more expensive than the reliever (though I could be wrong on that - anyone know for sure?). So this could turn out to be a costly mistake.
I've had a Salamol inhaler for several years and it's no different, for me, from Ventolin. I mainly use a DuoResp Spiromsx 320/9 inhaler, which works so well that I rarely need my reliever inhaler, although I always have it with me.
I think this is about money. It is also about staying alive! Asthmatics should be given the one that works for us. My ( then useless) asthma nurse insisted that I change. I went back as it just didn’t work as well as the ventolin inhaler for me. She said I had to still have it because they are no longer making ventolin. Saw the GP and got it changed back to ventolin and still on it. Luckily stupid woman left and lovely new asthma nurse replaced her but I was cross. Without sounding too dramatic - This can be about life and death! I figure as a family of vegans and vegetarians who recycle and try with everything else I am not going to give myself a hard time on something I absolutely need!
Quite. I work really hard to try and keep my health as good as possible (good diet, exercise, etc). And yes it does all help, even though I have to miss out on certain foods and drinks because my digestive system objects to them. I don’t request or expect medication unless I really need it. But when I do need it and it’s one that my life depends upon, and it’s one that is readily available, I expect it to be there (unless, of course, they’ve come up with a new, much better alternative, but from the sound of it, this isn’t one of those).
Thus far I’m still on ventolin. My latest accuhalers were issued early this year and are ventolin rather than Salamol. They also still have a good amount left in them. And as they’re accuhalers they certainly don’t contain any cfcs, so that attempt at an excuse certainly won’t work.
I agree with you completely... you are not asking for something unreasonable or unavailable and you are not a bother generally. I am so pleased that you have the Ventolin you need. It is not a big ask really is it. 😀
yes a while ago the surgery put me on salamol which i did not like and stopped my ventolin,i am fortunate my asthma is very well controlled and i play badminton twice a week and often when over doing the running around i need ventolin as its quick to use.the other is not.
so after complaining about its use the doctor grudgling put me back on ventolin.playing baminton has improved my asthma really wel.,mind you i am now a 76 year old and excercise is important which so many older people in this country do not take part in.
I am sure being actuve and fit helps. I an not very good ar that! Good that your GP listened to you. 😊
I agree! I do quite a bit of exercise to help with overall fitness and strength (necessary for another medical condition I have) and find for the most part it helps. I’m going through a bit of a blip at the moment (which might be unseasonably damp weather related or it might be something else - due to see the doc this afternoon) which has meant that one form of exercise (doing mixed power walk/run) has had to be curtailed; I’m exercise induced and though I have an inhaler to help with that at the moment my lungs can’t take the running. But there’s no doubt that keeping myself fit has helped when it comes to fighting off/recovering from infections.
Sounds like you are doing all you can to help yourself. I have found there have been ups and downs and I used to love Zumba but then just couldn't manage it. I wanted to play the flute but didn't have the puff even for that but learnt to play the violin instead. In the past when breathing was such an issue even walking up a lot of stairs would be hard but it is no longer that bad thankfully. I had pneumonia a few years ago and every breath was exhausting, lots of headaches .. I had a holiday booked in Cornwall with friends the day after I came out of hospital and very nearly didn't go but the sea air was soooo good for my breathing, I am glad I went. I think there are areas (Thames Valley Basin) and parts of London that are known to be bad for pollution and breathing difficulties. Off on a bit of a tangent there. 🙄
It took me a while to adjust to the generic version but i persevered+ find it effective
Do you have to take more puffs? What did you have to adjust?
I think i did at first, just persevered
Ventolin both tastes and works better for me. Wish it had a counter though.
👍
I have read all the comments above, and am broadly on the same page. I, too, have found Salamol less effective than Ventolin, and I am dreading having to use it come the winter.
Out of curiosity I was looking up what research had been done on this, and found the following: pubmed.ncbi.nlm.nih.gov/181...
Thank you for the link - I hope the decision to promote Salamol over Ventolin wasn’t decided by this study which used 12 asthmatics and examined the effectiveness of ventolin, Salamol and ‘used’ Salamol inhalers. They were found to be equally effective. Rather simplistic: lots of people complain about the Salamol inhaler becoming blocked and not delivering doses until it is cleaned out and as there is a great variety in asthmatics and their responses then surely there should have been a much higher number of individuals studied.
I read a similar thing on the decision to swap people to Luforbec. This involved a small cohort of healthy adults. I wondered what the definition of healthy was. Incidently, the decision to change was predominantly cost. There was no mention of the environment. I think it was a MHRA ? (not sure if that is right - the people who authorise meds) document.
I suppose that providing the prescribing doctor is prepared to allow the patient to have the brand/ medicine he/she finds most effective, there’s no problem. However it isn’t a satisfactory situation when patients can’t get the product that works for them. The decision making process at MHRA, NICE or wherever should be open to challenge particularly when such weak research forms the basis for possibly life changing/threatening scenarios and also has very financially lucrative/penalising results. Challenge and review.
I agree! For me, even, that it seems to be done in lab conditions: I want to know it works reasonably quickly (10-15 minutes) when I am out for a walk in the colder season.
In the New Zealand hospital study comparing Ventolin and Salamol and the ‘used’ inhaler, there was some reference to 6 hours - I’m not sure what that was about. Basically I think we have to be prepared to stand up for ourselves and question decisions that affect us detrimentally.
Yes, it boils down to cost!
I had a Salamol inhaler go bad, it was disgusting. Never happened to Ventolin. By the way CFC's in the products affect the ozone layer and have nothing to do with climate change or your carbon footprint.
Salamol going bad sounds awful. Neither ventolin Evohaler nor salamol have CFCs they have both have HFA 34a. So apparently neither has a more detrimental effect on the ozone, atmosphere or climate change than the other. As some people have said, the promotion of Salamol is down to cost - and who knows what other financial incentives are involved. It certainly seems to be an inferior product.
Absolutely agree! Salamol is pathetic, its weak and you get a tiny little inhaler! I paid for mine, but now I cannot even get that becuase I am over 65, does the NHS want us to die?
If Salamol doesn’t work for you why don’t you try telling your GP that and ask to be prescribed Ventolin?
I did, but they wont .
I think the truth is in the cost. Salamol costs around £2 odd to produce where ventolin is nearer £10 or more. Ventolin works better, I had less attacks on Ventolin and they worked quicker too. Salamol is less potent or something in them is not as good and they don't last the full 200 puffs as claimed and the last of it is useless.
Funny how no matter what, we have to accept the inferior product because we are considered not worth it or as usual...
Money wins, it always does!
Don't forget, the pharma corps do not want you to be better, they want you sick because you are their profit.
I found the salamol inhaler to be tacky, an inferior mechanism/product to ventolin and I reacted to the alcohol in the propellant. So I’m back on ventolin evo. Melanie replied to me and said the propellant volume of ventolin is roughly three times that of salamol - this could be why so many people find it ineffective - needing two puffs or more each time. I also found that in order to get it to function properly I’d have to use both hands to compress the canister usually following a misfire after using one finger and thumb as I’ve always done with every other inhaler I’ve used!
I also find that the blue container gets blocked too frequently that it needs rinsing every time it gets used. It is very cheap, maybe we should move to Scotland 😂
I agree Salamol doesn't seem as forceful and doesn't work for everyone, but it's also partly done for environmental reasons. That's a separate issue with pros and cons for individuals which has been extensively discussed on this forum and elsewhere, but I don't think it needs a 'Big Pharma conspiracy' explanation.
Also. salamol is a generic medication which really isn't making anyone much money. If the pharma companies and manufacturers wanted to cash in, it would make more sense to push more expensive branded products. Which the NHS also generally isn't allowed to do - prescribing is supposed to be for the generic unless there's a good reason for branded (I take theophylline which *has* to be prescribed as a specific brand because the doses are different across brands. I don't think this is making pharma much money as it's a small niche drug that isn't popular among doctors or patients. I also know people who have asked for and been given specifically Ventolin because salamol is not working for them).
Moderator Comment: There will multiple reasons why NHS trusts make the change to alternative medications and for Ventolin to Salamol these include environmental impact, propellant amount and costing.
For all cases the change should be made after discussion with the patient and if something is not suiting with your asthma control then please go back to your healthcare provider to discuss alternatives.
Comments will now be turned off for this post to stop it becoming a discussion about pharmaceutical companies and theories. Please all refresh knowledge of the community guidelines.
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