GP restricting number of blue inhalers

[Photog24]

Hello, at a recent assessment, my ‘moderate’ asthma was deemed not under control. I have been on Bricanyl powder inhaler (blue) and the brown equivalent which name escapes me right now 🤦‍♀️ for the last two decades. I found that i have been struggling taking the powder inhaler and that, in an emergency, tried my daughter’s blue Ventolin inhaler and it worked much better. So, explaining this to my asthma nurse, she trialled me on a puffer inhaler, Soprobec, for my preventer and Salomol blue inhaler. There has been a vast improvement so my prescription has been updated.

I was quite surprised that I was ‘allowed’ to switch to a puffer as I know that there is a drive to move patients to powder because of net zero. Yes, in case anyone is not aware, this is why! I found this out after googling about my powder inhaler not working for me and found some NHS Trust information.

Anyway, my concern js that the nurse told me that i shouldn’t now need my blue inhaler as much because it should be more under control and that i am limited to three blue inhalers a year and that if i go over this on my repeat prescriptions, it will be flagged. This will mean my prescription won’t be authorised and I will then have to request an appointment, which, at our surgery, takes about a month to happen! This is giving me anxiety and I find myself trying to resist taking my inhaler in fear of running out. I have already ordered two because I need to keep one in reserve in case one is lost or fails for some reason (only natural and common sense, right?). It’s giving me ‘range anxiety’ 😅

Has anyone else been restricted in this way? I can’t help but think that this is cost cutting and/or net zero targets.

[Mandevilla]

Try not to panic about the limit on the blue inhaler - I know three a year doesn't sound much, but it's actually quite a lot of doses and the limit is in place for your own wellbeing, because if you need to use your inhaler three times or more a week, then your asthma is not well controlled and you need to go back to your GP for a review anyway! Assuming around 200 puffs per reliever inhaler, getting through three in a year would mean you are using it way more than three times a week.

Just keep an eye on how often you are using your reliever, and if it creeps up to the three times a week mark, make an appointment straight away rather than waiting until you need a new inhaler. I mark on the calendar every time I use mine, and also make a note of any special circumstances that might have triggered the need for it in case the surgery queries it - e.g." Yes, I've used a lot but that was when I had Covid last month and I've only needed my reliever once a week since then."

I have two inhalers 'on the go' at once. I keep one by my bed (I don't usually get trouble at night, but when I do, the last thing I need is to be hunting around the house for my reliever!) and the other with my keys, so I never leave the house without it. I have a strip of masking tape round each one, so when I use it, I make a mark so I can keep track of the number of doses used. When my 'going out' inhaler is about 3/4 used up, I swap it for my 'home' inhaler and put a request in for a third one.

Whatever you do, don't stop using the reliever if you need it - just go back and say that your asthma is not well-controlled because you are having to use it three times a week or more

[Photog24 in reply to Mandevilla]

Thank you Mandevilla, that is a really good explanation. I wish I was as organised as you! Life is crazy and it’s not always easy to stop and think but I will try to somehow keep check.

[Mandevilla in reply to Photog24]

I'm not very organised generally, but I'm super organised when it comes to my inhalers because I'm scared of running out. I had an issue last winter where my surgery's computer system had a blip and wiped Ventolin off my record and it took me days of arguing to get it reinstated and of course all the stress meant I was needing my reliever more than usual and running out. Up till then, I waited until I was almost out because of all the pleas not to 'stockpile' medication, but since then, I've made sure I never get too low.

[Photog24 in reply to Mandevilla]

Makes perfect sense, thank you!

[Purpleotter in reply to Mandevilla]

I have 12 blue inhalers per year, and need to use them se eral times each day, my asthma is not well controlled although since being prescribed prednisolone I've seen a vast improvement.

[peege]

Ventolin inhalers have been restricted in several areas now. A year or so I was given Salamol (which some members say doesn't work as well as Ventolin). I'm yet to try it as my asthma is well controlled with my MART spray inhaler with spacer and at times of exacerbation I've had leftover Ventolin There seems to be a move to prescibe 'combination' inhalers. Mine is Fostair 100/6 which is under the MART (mart = maintenance and reliever therapy). Both powder & spray type Fostair are MART.

Personally I'm thrilled with my combination inhaler but I did have a text from the surgery last time I requested a reliever that I shouldn't need it and it wouldn't be supplied next time 😳.

Check what your Soprobec contains and if it's MART, if not speak to your medic to discuss your worries - ASAP to put your mind at rest. The helpline is 0300 222 5800.

In my personal opinion if my asthma is controlled I can walk to places if not I'll use my non electric car raising my carbon footprint. I very rarely fly, use oven, a dryer, eat local produce where possible, heating is set at 16° and to come on in December (for financial reasons).

So, how flipping dare they restrict lung patients. Grrrr

[Photog24 in reply to peege]

Thank you Peege. It’s very frustrating as I know my daughter’s Ventolin works much better than my Salamol but there is less propellant in it so it helps meet their net zero targets. It’s wrong in my opinion. I have seen a lot of threads here with people saying the Salamol doesn’t work as well or that the powder inhalers they have been switched to don’t work. People’s lives could be at risk and further pressure on services. I had a repeat prescription request cancelled and they didn’t tell me and I only found out after going to collect from my pharmacy. I then had to wait a month for an appointment. Never mind that I can’t breathe, hey?! Hopefully, this new regime will work.

[Homely2 Administrator]

I have been restricted to four salamol a year, my GP practice now has a pharmacist, who saw fit to adjust my meds without telling me.

In theory this is fine as I should not need four salamol a year.

But it means that I will have to see my GP asthma nurse when my asthma moderately deteriorates for extra salamol rather than waiting for severe deterioration. This is all medically correct in theory, but hard in practice.

[Photog24 in reply to Homely2]

I feel your frustration. It’s so hard to get an appointment too!

[Poobah]

I'm an old codger now, but in the distant past, it was acceptable to use Ventolin before taking the steroid preventer inhaler, so I was taking Ventolin twice a day plus several times as a reliever. Even when I was prescribed Symbicort, around 20 odd years ago, a combination inhaler (steroid & long acting bronchodilator), no one told me not to take the Ventolin before the Symbicort. So my Ventolin use was heavy but no GP or consultant ever questioned that level of use.

It was an asthma nurse who first asked me about my Ventolin use and she was horrified that I was taking it before using my Symbicort. I was equally horrified when she explained that I shouldn't be taking it more than 3 times a week. Despite having been under a hospital respiratory consultant for years, it was my asthma nurse who changed my Symbicort to Fostair and I was able to reduce my Ventolin use. I now take around 2 puffs a month when my asthma is controlled. That level of use changes during a flare up, but my trigger to make an appointment with the GP or asthma nurse is an increase in Ventolin use. It's a sign I need additional treatment in order to bring things back under control.

So if you're still experiencing symptoms that require Ventolin more than 3 times a week, it may be a sign that your preventer isn't working for you and your doctor or asthma nurse should look at changing your preventer treatment, either increasing the doseage or inhaler. They may consider prescribing a combination inhaler, containing both a steroid and a long acting bronchodilator. It's important to get your treatment right so that you're not dependent on daily Ventolin.

All I can say, it's fantastic to be able to enjoy a level of asthma control that's not so dependent on daily Ventolin. I'm grateful that I've been able to achieve that. But everyone is different, however, the goal should always be to achieve the best possible control for every patient.

[Photog24 in reply to Poobah]

Thank you Poona. I recall the days that I was told to just use my blue inhaler as I needed it and wasn’t even on a preventer inhaler until a few years ago. I’ve definitely noted an improvement since switching from a powder inhaler to a puffer. It does feel better to have it more under control. I am even managing to do my workout without a puff of Salamol (most days), so that is a huge improvement.

[Patk1]

Try not to worry.u maynot need to use it as much if mdi inhaler works better for you.ru using an aerosure spacer device with them x

[Photog24 in reply to Patk1]

Thank you. I am using a spacer with the preventer inhaler but not with the blue Salomol inhaler and seems to be fine. The Salomol doesn’t have as much propellant in it so seems easier to take without a spacer

[Patk1 in reply to Photog24]

I still use a spacer with salamol as they say we get 25% more of it into lungs. Don't let yrself run out,order in plenty of time x

[Photog24 in reply to Patk1]

Thank you.

[Chip_y2kuk]

Realistically your blue should be used infrequently

And by limiting you to three... you are forced to make an appointment... which stops you struggling on your own and getting worse

Something like 7 out of 9 asthma deaths are preventable and sadly most of them are due to people going it alone and not knowing when to get help.

So your GP limiting you to three is to *ensure you get help* and I think its a good thing.

Also your new inhaler is a combination inhaler so as your asthma nurse has already said you *should* need your blue infrequently (if at all) and if your not after it's had time to work... you definitely need to be seen again.

[Photog24 in reply to Chip_y2kuk]

Thank you Chip. I’m glad I did have my review and that the nurse was so thorough because I was struggling. I realised that my powder inhaler wasn’t working for me anymore so the new Soprobec is working much better now and I haven’t needed my blue inhaler much at all so that’s reassuring. The Soprobec is a preventer, not a combination inhaler, as far as I am aware.

[Chip_y2kuk in reply to Photog24]

Yes your right, it's beclomethasone and not a combination.