‘Unprecedented’ demand for inhalers


asthma reliever puffer on its side

Salbutamol inhalers are in very short supply, pharmacists report, but TGA reassures these are temporary local issues that will be corrected with new limits on sales and orders

Ventolin and Asmol have been in short supply around the country this week, say pharmacists, with some remote towns reporting “critically low” levels.

“We have been smashed… there is none available,” Sydney community pharmacy proprietor Caroline Diamantis told AJP.

“They sold out and quickly went on back order as I started realising this could be the next ‘toilet paper gate’. I have long list of numbers to call when it finally comes in.”

Tasmanian pharmacy owner Joseph O’Malley says Ventolin is now being rationed by the wholesalers.

“Our pharmacy seemingly can only order approximately two dozen at a time. We’re not expecting any stock to be available to the pharmacy market until the middle of next week,” he told AJP.

However he adds: “It’s worth knowing that all the Ventolin is imported from the UK whereas Asmol is manufactured in Brisbane by Mylan. So at least there’s one manufacturer that’s supplying the local market.”

Small Pharmacies Group (SPG) has expressed frustration at supply issues that it says are creating “pandemonium on the ground”, particularly in rural areas.

“SPG has received numerous reports about stock issues all over the country. Some of the most serious problems reported include no Ventolin or Asmol in Cowra – a rural town with a population of over 10,000,” says the group.

“There is a very remote town in NSW critically low on asthma meds – they will run out of Ventolin today and the hospital has nothing either.

“Additionally there are reports of orders not turning up for three days or more from first-line wholesalers, even in metro areas such as the ACT and Melbourne. [Some] pharmacies have insufficient supply to pack DAAs for their most vulnerable patients.”

A spokesperson from the Therapeutic Goods Administration (TGA) told the AJP that it is aware of an “unprecedented increase in demand” for salbutamol inhalers (puffers) in Australia.

GSK and Alphapharm have advised the TGA that there is stock of Ventolin and Asmol puffers available.

“However, the high level of demand has resulted in some wholesalers and pharmacies reporting that salbutamol inhalers are out of stock,” says the TGA.

“These are temporary, local-level out-of-stocks, and not national-level shortages.

“Pharmaceutical companies have advised the TGA that they do not anticipate imminent or widespread national-level medicine shortages due to potential impacts of COVID-19 on their manufacturing or logistics.

“However, if current levels of demand through excessive purchasing (stockpiling) continue, supply interruptions will occur at both the local and national levels.”

As announced on Thursday, pharmacists will now be required to limit dispensing of certain prescription medicines to a one-month supply at the prescribed dose, and sales of certain over-the-counter medicines including salbutamol inhalers to a maximum of one unit per purchase.

To ensure access for patients who require these reliever medicines to treat symptoms of asthma and COPD, pharmacists will be required to confirm the patient’s diagnosis, label the product indicating to whom it has been dispensed and record the supply.

“These limits on pharmacy sales will be accompanied on limits on orders from wholesalers, to ensure equitable distribution of stock,” says the TGA.

The Pharmacy Guild’s Trent Twomey said at APP2020 on Friday that the organisation was having “twice daily conversations” with the TGA and the wholesalers, “to see how we can pull the handbrake on the supply” of salbutamol.

“Unless we do something drastic to slow down the run on these molecules, we will run out quickly. Hence why the TGA has started with the measures introduced yesterday,” said Mr Twomey.

Meanwhile the National Asthma Council Australia has called on pharmacists to prepare their asthma patients as COVID-19 spreads and the influenza season arrives.

There is not enough data to know exactly how COVID-19 affects people with asthma, says National Asthma Council director and respiratory physician, Professor Peter Wark.

However from previous experience people with asthma are expected to be at higher risk of serious illness if they contract the disease.

“Healthcare professionals can help by speaking with their patients about the importance of using their preventer, updating their action plan and checking device technique,” he says.

Pharmacists are also recommended to urge patients to take extra care during the upcoming flu season and offer vaccination if appropriate.

The Council encourages people with asthma to make sure they have enough medication to last a month, but adds “they should not stockpile as increased demand has led to shortages in some pharmacies this week”.

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