With a looming shortage of some salbutamol nebules, here’s what to use instead.
Advice on how to treat patients who need salbutamol nebules but cannot access them has been released, ahead of an anticipated shortage.
The National Asthma Council Australia said they expected a shortage of salbutamol inhalation solution 2.5mg/2.5mL (Ventolin nebules) from August this year to June next year.
Manufacturer GlaxoSmithKline Australia said the shortage did not apply to the 5mg/2.5mL salbutamol inhalation solution or any other Ventolin product.
In a National Asthma Council update, the organisation’s clinical executive lead Debbie Rigby recommended using a pressurised metered-dose inhaler (pMDI) in combination with a spacer to deliver bronchodilators for patients with asthma or COPD.
“A pMDI plus spacer is at least as effective as a nebuliser in outpatient, in-patient, ED and intensive care units across all ranges of severity of acute asthma among adults and children,” said the asthma educator.
In the National Asthma Council recommendations, Ms Rigby said historically there had been a belief that salbutamol delivered via a nebuliser was more effective than inhaled therapy during acute asthma exacerbations or COPD.
“Comparison of nebulised salbutamol therapy with pressurised metered dose inhalers (pMDIs) plus spacer or dry powder inhalers (DPIs) shows no difference in clinical outcomes among patients with asthma or COPD,” she said.
Ms Rigby said salbutamol delivered via nebuliser required a higher dose without added therapeutic benefit.
“The dose equivalent to 5mg of salbutamol delivered by nebuliser is 10-15 puffs of 100microg salbutamol by pMDI plus spacer.
“Nebulisers deliver a lower fraction of the prescribed dose than a pMDI plus spacer – approximately 10% versus 20-30% – and therefore larger doses are prescribed.
“Administration of salbutamol by pMDI plus spacer is more effective than by nebuliser because a greater dose is delivered in a shorter period of time and a larger dose is delivered to the lungs as the result of greater targeting efficiency.”
Ms Rigby said extrapulmonary adverse effects such as tremor, heart rate and anxiety were more likely with drug delivery via nebules compared to pMDI plus spacer, related to the increased dose.
In May, manufacturer GlaxoSmithKline Australia sent a letter to healthcare providers warning them of the potential shortage to give them as much time as possible to plan.
“The supply shortage is the result of an unexpected increase in patient demand and limited scope to adjust the manufacturing capacity to meet this demand,” the letter said.
“There are no quality concerns with the nebules currently supplied in Australia.”
A spokesman for the TGA said it was working with GlaxoSmithKline Australia to monitor the supply of the medication, and the TGA had not been notified of any supply issues with any of the higher strength salbutamol nebule (5mg/2.5mL) products.
“There are alternative brands of this medicine registered in Australia, and the TGA is working with the sponsors of those products to determine supply capability in the lead up to the anticipated shortage start date,” the spokesman said.
“In the lead-up to the shortage start date, the TGA will investigate the potential for future approvals for importation and supply of overseas-registered salbutamol inhalation ampoule products under section 19A of the Therapeutic Goods Act 1989.”