GP refusing to prescribe more than 1 reliever

[Tittlemouse]

I'm new here and would appreciate some advice! I've had asthma for nearly 40 years and was taking symbicort and ventolin as a reliever. My GP has now refused to prescribe more than 1 ventolin inhaler per prescription and said I should need only 1 or 2 per year. I think I use about 4, partly as I run/do gym 4 times a weeks and use 2 puffs beforehand as advised by them. My GP just kept repeating that he would only prescribe one, ignored what happens if it is lost/runs out and did not respond to my points about it being difficult sometimes to judge how much is left in an inhaler and that presribing two does not mean I'll use twice as much. He's moved me on to DuoREsp purely as its cheaper so I'm feeling a bit daunted and about whre to go from here. Any advice??

[elanaoali]

This has happen to someone else before on here. I think that this is driven by money saving for NHS. I am very blessed to have a doctors who are very careful with the rescue steroids as it should be. However they let me have 3 adult spacers one for home, one for my handbag and one for my rucksack. This last two I have on me at all times. I currently have one ventolin for each spacer and two spares. I agree its very hard to know how much you have in them. Seretide 250 which I been allow to keep even though it costs more than a powder form as I need this kind to do my inhaler probably with a spacer. My asthma nurse was fine with this and I said how much I appreciated this as I know its more expensive and takes longer to work than newer ones. ie. 15-20 mins but I factor that in to my day too.

With ventolin I know it has 1,000 puffs but there is no way of knowing when you are going to run out. I try to use mind in date order.

We are all human and lose inhalers doctors must know that but I think that perhaps he is being pressured in to saving money. Who knows?

I suggest you take to asthma uk helpline to help you with your case with their back up doctors in my experience take notice of what they say. Not just the ordinary asthmatic.

[Hidden]

Hi these are 2 separate issues. Doctors are prescribing duoresp because as a generic version of symbicort it is cheaper. However it doesn't work well for everyone and when I was changed to it I rang the doctor and told him it wasn't doing the job and he immediately changed me back to symbicort. You need to give it a try though as it does work well for some people.

Re the blue ventolin inhaler, recent research has led doctors to restrict the use of it and the latest thinking is that you shouldn't need to use it more than 3/4 times a week. I was told to up my preventer (symbicort) instead as that also has a reliever element in it. You need to ask your doctor/nurse about doing this. So if I am extra breathless I double my dose of symbicort and have found I don't need to use the ventolin as much. x

[Hidden]

That is outrageous and is not the case at the practice I go to. I always have two ventolin accuhalers - the reason being that with two I have the option of keeping one in my bag (so I don't have to remember to pick one up before I go out) and one that stays at home.

The reason I have accuhalers is that they have a counter on them, so you can see how many doses you have left. The medication comes in dry powder form, which not everyone likes, but the inhaler is so much more practical.

It is true that if your asthma is well controlled you should hardly ever need to use your ventolin inhaler and in fact with me my ventolin accuhalers usually reach the expiry date before I run out of doses. But even so, common sense should dictate that having two ventolin inhalers, one that stays in your bag and one that stays at home, reduces the risk of you being caught without one. Oh but of course I was forgetting, common sense is not common, and just because a doctor has been clever enough to get to medical school does not guarantee that he/she is going to be strong in the common sense department:-).

I agree with elenaoli. Give the AsthmaUK helpline a ring and ask for some advice from them.

[Tittlemouse]

THanks for the replies, I was left thinking that I'd be sensible to reduce gym/running as this is the thing that really tends to make me use ventolin but it does help my lung capacity. I wasn't advised to up my DuoResp dose as an alternative so I'll ask about that when I write and complain. I still can't believe he told me to just "pop into the surgery, any time" if I did lose one, it takes a minimum of 48 hours to get a repeat prescription and thats just monday to friday. It felt as though I'd end up using out of hours services or A and E which is ridiculous when I've managed my asthma ok and certainly don't overuse ventolin.

I'll ring Asthma UK tomorrow and see what they advise

Thanks for your replies

[Chip_y2kuk]

I think with doctors there are two trains of thought

- current advice is that if your are using a lot of ventolin your asthma is not well controlled

-prescriptions cost the nhs money and they are under pressure to reduce costs

However my doctor doesn't mind me having spare inhalers knocking about they just insist on them being an inhaler an item (thus costing £8.40 per inhaler).... which is fine I just want the spares

[Emmaleigh]

Boots will issue you with an emergancy blue inhaler should you need one- I learnt this the hard way when My inhaler fell in a mcdonalds toilet from my back pocket

[FairyfeetX]

I'm rural, 5 miles from the surgery which also dispenses prescriptions. I need the security of spares in case I can't drive or if we have a shocking winter - in which case I won't drive! We shouldn't be made to feel like we're trying to get hold of some desirable drug.

[Tugun]

Hi,

He obviously doesn't have any real experience with Asthma. Get another doctor!

[Hidden]

Hi it is shameful, I would change surgery. He hasn't grasped that the duo respi is not a replacement for Ventolin. However don't have more than 6 puffs a day if you can help it, it does develop a tolerance. Last week I had the reversibility test and had to have 4 puffs, well my peak flow didn't shift..Good luck!

[risabel59]

I think that it is quite difficult for your G/P, as I have had the "ventolin inhaler" conversation with a number of doctors. I think its very tricky to get repeats in the UK, but my consultant in America would only prescribe one ventolin inhaler at a time. while he was perfectly happy to prescribe 3 months of every other drug I take. His logic being, OK you need it for exercise say 4/ 5 times a week, That's 10 puffs, So it should last 20 weeks for exercise. If you are using your reliever more than twice a week for anything else he wants to know about it. In his book using a reliever more than twice in a week for anything else than exercise means that your asthma is uncontrolled. This decision had nothing to do with money as I paid for all my own medication.

My current GP is relaxed about prescribing ventolin but both he and my consultant want to know exactly how much I am using outside of exercise. And I know that I will be asked about this.

However, like many of the other respondents, life is tricky, I find you need an inhaler in your gym bag, you need one in your handbag, and you need one at home for when you've "lost" the other two. I have found that keeping an asthma diary with peak flow and use of medications, really helpful in persuading doctors with what they should prescribe. Also it will mean you have some idea of how many inhalations are left in your inhaler.

Its all very well for your Doctor to think he wants you to keep coming back, but with the difficulty of getting appointments, its really hard. I would try and come to a compromise with him. Ie if you use your reliever inhaler more than 4 times in any one week outside of exercise you will make an appointment.

In terms of the DuoResp, I can only say give a try as it pretty much has the same ingredients as symbicort. Do you have an asthma plan, as DuoResp can be used like a reliever if you are symptomatic?

[Matti21]

DuoResp as said is the cheaper version of Symbicort but can't be used as smart regime ie increased doses. I am under respiratory team and currently taking 7 puffs Ventolin day and they're aware. Your GP is being extremely unhelpful however well controlled asthma only needs very few puffs Ventolin unlike mine!! I'd write a letter a state how you feel and it's scanned into the system and say limited prescription of Ventolin is causing anxiety and bringing on symtoms. If DuoResp doesn't work Yippee within your rights to request it be back to Symbicort saying it made your symtoms worse. All money related, sickening as I'm a nurse myself with chronic unstable asthma. Good luck.