Several GPs and practice pharmacists using the MIMS drug shortages tracker have told MIMS their patients are struggling to obtain inhalers including Ventolin Evohaler (salbutamol), Clenil Modulite (beclometasone), Kelkale (beclometasone), Qvar (beclometasone), Soprobec (beclometasone), Flixotide (fluticasone), Fostair (formoterol/beclometasone) and Seretide (salmeterol/fluticasone).
However, manufacturers say there are no coronavirus-related issues with their supply chains and the shortages are being caused by a sudden increase in demand.
Glenmark, manufacturer of Soprobec, says it has seen an increase in demand for the product from 2,600 packs a week to 132,000 in the last week – a 50-fold jump. Chiesi, manufacturer of Clenil and Fostair, says it has had a four-fold increase in orders for its inhalers.
The MIMS shortages tracker currently lists supply problems with only one inhaler: Flutiform K-haler (formoterol/fluticasone) 5 microgram/50 microgram, for which only stock with a shelf life of less than 6 months is available.
Guidance for prescribers
Manufacturers and professional bodies have appealed to healthcare professionals involved in prescribing and dispensing to help ensure that supply can be directed to those who need it most by not writing multiple prescriptions.
In guidance published on 1 April 2020, the British Thoracic Society says prescribers should continue to write monthly repeat prescriptions for inhalers, and should discuss with patients who have not ordered a repeat prescription for an inhaler for more than 4 months if this is still clinically required.
The guidance also advises prescribers not to switch between different types of inhalers 'unless essential to ensure continuity of patient treatment'. In this situation, patients should be switched to an alternative class of device (ie, an aerosol [eg, metered-dose inhalers, Easibreathe or Autohaler] or dry-powder inhaler).
The Regional Drug and Therapeutics Centre has issued guidance on steroid inhaler prescribing during the coronavirus pandemic, saying steroid inhalers should not be supplied in response to requests from patients who do not require escalation of therapy or who are requesting supply on a 'just in-case' basis. This includes patients who have not requested a steroid inhaler in the previous 12 months or who do not have steroid inhalers included in their asthma or COPD management plans.
Sarah MacFadyen, Head of Policy and Public Affairs at The British Lung Foundation, gave similar advice for patients, saying 'we are urging everyone with lung conditions not to try to stockpile medicines during the coronavirus outbreak, get their prescriptions earlier than usual, or get more inhalers than they need. This won’t be allowed and causes problems for others. We have also been asked by people who have not been prescribed a preventer in years, whether they now need to get one. Our guidance is that if symptoms are coming back or getting worse, then this is when people should arrange to see or speak to their GP or respiratory nurse but not to get a new preventer or start taking it on their own, without getting medical advice.'
In a letter to GPs on 5th March, Dr Nikita Kanani, Medical Director for Primary Care at NHS England, warned practices not to change their repeat prescription durations or support patients trying to stockpile as this 'may put a strain on the supply chain and exacerbate any potential shortages'.
Dr Kanani said: 'Practices should consider putting all suitable patients on electronic repeat dispensing as soon as possible. The whole repeatable prescription can be valid for a year but each repeat should be for no longer than the patient has now. For example, if the patient has prescriptions for a month’s supply now then the repeat dispensing should be set up as 13 x 28 days’ supply.'