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Repeat prescriptions

For over 30 years I’ve controlled my asthma using ventolin inhalers with the instructed dosage of 2x puffs 4 times daily or when required.

Recently my request for a repeat prescription has been made difficult as the asthma Nurse at my doctors surgery informs me using my inhaler more than 2 times a week is excessive and my asthma is out of control!

I have done some breathing tests at the surgery and have an appointment at the hospital last Dec.

Previously I have been issued 2 inhalers with each prescription which always means I have one in reserve.

Nowadays I am informed one inhaler is meant to last 30 days, which it doesn’t, and have to argue for a repeat on every occasion.

Moreover, I am now using online services to purchase medication as I don’t need the stress

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Without your medical notes it’s difficult to know the reasoning behind your regimen, but on the face of it it seems to be quite outdated. These days the rule of thumb is that if a reliever inhaler is required more than twice a week then the asthma is not as well controlled as it could be and preventative medication would be added in (or swapped or dosage adjusted if already on preventative meds) in order to reduce symptoms and need for the receiver inhaler. People who use a lot of reliever inhaler are generally at a higher risk of having an attack as although they may be managing symptoms the underlying inflammation that drives the airway hyper-responsiveness it not being adequately treated. Again this is a generalisation all asthma is individual and I don’t know your medical history, but it may be worth asking for an asthma review to talk about these issues with those who do know you and have access to your records. If you are under a consultant you could try contacting them to talk through your treatments whether this is still the best regimen for you or if you could benefit from trying something else. If they feel that salbutamol alone is still your best option they can write to your surgery to tell them as such and to stop limiting your supply.

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Clearly your asthma is out of control. Ventolin is usually needed in case you have flare-up or exacerbation. This means once or twice in few months. In my case once in 3 or 4 months. What you need is a long term preventer. Consult your GP.

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You do not have moderate to severe Asthma!

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Hi - I’ve pulled this directly from the asthma UK website:

“IF YOU'RE USING YOUR RELIEVER INHALER A LOT

If you usually take your reliever inhaler three or more times a week you’re only dealing with your immediate asthma symptoms. What your reliever can't do is deal with the underlying inflammation that’s causing them. This means that your airways are less able to cope with asthma triggers and you’re at a much higher risk of an asthma attack.

Also, using your reliever inhaler regularly could mean that your body starts to get used to the reliever medicine and you need higher doses for it to work.

Keeping an eye on reliever prescriptions

If you think you’ve collected more than 12 prescriptions for your reliever inhaler in a year (or you get through more than one inhaler in a month) see your GP or asthma nurse. It could be that your asthma's not well managed and you're at higher risk of an asthma attack.

Of course what really counts is how many reliever inhalers you’re using – you may have collected your prescriptions (especially if you’ve got a repeat prescription) but not used them.

Some people get more reliever inhalers to have as spares, perhaps to keep in the car, or at school or work but are not necessarily using them.

If you can’t remember how many reliever prescriptions you’ve collected, and are worried about your risk, the key question to ask yourself is: am I using my reliever inhaler three or more times a week?

If you are, your asthma isn’t well managed and you need to see your GP or asthma nurse to review your treatment. “

(This is me now 😅)

The aim of your preventative medicines is to not require your reliever at all, so the advice to take 2 puffs 4x daily of ventolin without telling anyone is not correct (or very old fashioned), and if you’re going through a ventolin in a month (or less) it does mean you’re not controlled. Excessive use of a reliever due to necessity (ie needing it all the time) can lead to your lungs either adapting to the drug (so it’s less effective), or your lungs adapting to the symptoms (and causing other respiratory diseases). The only time this treatment is advisable is; recovery post-hospital advised short-term by doctor or if you’re a severe, uncontrolled asthmatic when you’ve tried all the alternative drugs and they don’t work.

If your pump isn’t lasting the month and they won’t release a new one, then make a GP appt to discuss it/what drug you can try to need it less!

Try taking this asthma control quiz, as it’ll tell you how your control is (ie your risk of flare up) and also show you what answers they expect from a well controlled asthmatic! asthma.org.uk/advice/manage...

Hope that helps x

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The control quiz is ok, but dosn't give context and seems somewhat similar to the annual review, ie. tick box mentality.

a) Does not ask how long you've been asthmatic

b) Does not ask if you have long term lung damage (as I have) as a result of being on wrong medication for years, and being born in the 50's when there wasn't asystem of preventive treatment available.

c) I also have white coat syndrome so when my blood pressure is taken it is high, especially when its taken just after asthma nurse has been pressurizing me to change my medication, which I don't want to do because my present regime works fine.

These experiences don't endear me to this sytem. Instead of feeling looked after and cared for, I feel traumatized , belaguered and stressed. There are no questions about what other medications you have been on, which have worked, which havn't. It seems I have to keep fighting to stay with a regime that works for me, I don't have any side effects (one medication I was on gave me the shakes, I was a working goldsmith at the time-very useful). I can do what I want to do when I want to do it. My peak flow isn't great because of lung damage. Yet I continue to do what I want when I want. I am 65 and have had this disease all my life. I never thought I would make it to 50 never mind 65. All this info is context and none of these questionnaires address this.

Rant over !!

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I use my Ventolin inhaler a lot. I'm 66 and very active. My GP has never said use less. I get through three a month and get three on repeat.

I was diagnosed with Asthma in 1955 and that would qualify me as expert.

I have had a brilliant life so far and only hospitalised about a dozen times.

I do have a lovely Asthma nurse who looks at my lifestyle and health and when she notes that I am doing OK never suggests a change in medication.

My asthma consultant at Derriford Hospital did prescribe me Relvar Ellipta and Incruse Ellipta (best Google that!) as I can't handle the brown inhaler as I get oral thrush and coughs..... The Relvar and Incruse (we call them Friskies as they come in a container like cat food. I have had no major asthma attacks for an age.

I asked a young male asthma nurse of about 25 what one thing he does to ward off coughs, colds and flu... He said Vitamin C and Zinc effervescent drinks once a day. I bought a tube from Boot's right away and honestly can say I've not had a serious chest event since. The drink is quite refreshing and with no sugar. I take my inhalers right after as my throat is clear of any gunk.

OK I can't run a marathon but I do get out and about a lot (inhaler in pocket)

David

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I know recent tests have the medical profession saying that anyone who needs to use their ventolin more than a few times a week need their preventer inhaler looking at as they might well need a change or upping. The tests show it is a sign of uncontrolled asthma.

Now I am no medical expert so can't say whether this is right or wrong but this is the reason behind doctor's refusals to prescribe ventolin as much as previously. x

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I’d like to thank everyone for their replies and advice.

Wrongly on my part I neglected to say that I do use a pink proventative inhaler and am awaiting a breathing test.

I know my use of ventolin is excessive, which has varied consistently since diagnosis.

I also understand that modern medicine as well as understanding of asthma brings about change of how it’s treated.

My issue still remains as well as concerns me, as I know all asthma sufferers will relate.

Until my asthma is brought under control I have to manage it as I’ve always done and the stress of obtaining a repeat prescription earlier than 30 days and the thought of being without any relief causes panic!

Where do I stand when being denied repeat medication or the stress I have to go through each time I apply for it ?

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If you’re struggling to get another ventolin on repeat prescription, you’re best bet is to book an appt with the doc (emergency or otherwise, depending on how much you’re using it/how much you have left). Then you’ll usually get one as face-to-face a doc won’t refuse if you say you’re out - it’s irritating but it’ll also highlight to them that you may need something more/ that you’re not that controlled at the moment (esp if you have to keep doing it). Your doc may even ‘double up’ your script if you talk to him about it!

I hope that helps and things get sorted for you soon x

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I too use my ventolin @ two puffs every four hours just as my Dr. PRESCRIBED. He wouldn't have done so if it's not an OK treatment. I have two different Dr's. so I get each one to prescribe for me each month. That way I have back-up if I need it. I use two different pharmacy's also so I don't have a refill problem.

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Join the club!!!

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Would strongly recommend you request a referral to a respiratory consultant as even with a single pink preventer your medication seems a bit light and old fashioned. I am 60 and have had asthma since I was a few months old- am on Singulair tablets nightly, spiriva inhaler 2 puffs nightly and symbicort 2 puffs twice daily - only use ventolin pre vigorous excercise generally. symbicort can be used as a reliever as part of a SMART programme. Good luck

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Hi,

I'm sorry you are struggling with the nurse. I have had the same issue and I contacted Asthma UK direct for advice.

They were great, advising I go back to the nurse and explain she had made me feel FOOLISH when talking about the amount of Ventolin I used and had embarrassed me. I then went on to explain ALL the times I need to use the Ventolin including exercise, even a walk to the shops, during summer/winter pollen periods. Heavy traffic times around my home etc. However, they also made it VERY clear that the nurse has no right to blatantly REFUSE giving you the Ventolin if your history shows you have always had TWO.

Remind her that the "RULES" she is using are only GUIDELINES. Each individual is different and requires that individual treatment and that is STATED in the guidelines alongside the Asthma UK's input, this is what should happen. If she still refuses to allow the prescription go in to see the Doctor as he/she may defer to her as appointments are tight, but in the end HE/SHE is the person to DICTATE your meds. They SIGN your prescription and MUST agree to them.

BE BRAVE I was and the nurse was actually very understanding and couldn't apologies enough for making me feel like a fool.

Best wishes

Jan

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See I am under a respiratory consultant. I am told to use my accuhaler 200 Ventolin. Five puffs every hour during a flare up. Yet when I am well I often do not use any for weeks. I am issued two a week when required but only order every 28 days most of the time. I often have two puffs before a shower (twice a week) and two puffs before exercise group (once a week) but i do not class this as taking it for symptoms. This is a preventive measure. I think the key is to remember we are all unique and all have different dna. So all require slightly different treatments. I am back seeing my respiratory consultant on thursday as I was put on a preventer and it has caused havoc. Peak flows are irratic and blue inhaler usuage gone through roof. He will be getting that one back! Stick to my trusty blue!

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Hi. Like you I have to use my Ventolin inhaler more than I 'should'. The consultant I have seen accepts it is necessary as does the local doctors surgery. I have Bronchiectasis alongside severe asthma. Please (if you haven't already) see your gp and explain. As you say, you don't need the additional stress. Good Luck

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I’ve had exactly this issue with my gp, when u go to hospital tell them that go won’t allow a spare and they will write to your surgery

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I’ve had this too. Wouldn’t give me a ventolin inhaler as asthma review was due. They did give me the preventer as requested. Good job I didn’t have an attack and end up at A&E ! I have also resorted to online purchase of ventolin in the past too. Had the review now, which was just a complete box ticking exercise. They didn’t even take my peak flow until I asked.

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