NHS hospitals have been hit by a shortage in Britain of a life-saving drug used to keep patients alive who are at risk of dying because they cannot breathe without medical intervention.
Doctors have been told to ration its use liquid form of salbutamolwhich plays a crucial role in treating people suffering from severe asthma attacks or chronic obstructive pulmonary disease (COPD), which usually involves emphysema or chronic bronchitis.
A “safety critical” national patient safety alert issued by the Department of Health and Social Care (DHSC) and NHS England warns that there is a shortage of 2.5mg and 5mg salbutamol liquid vials. The latter is “out of stock until mid-April 2024”.
The shortage is so acute that hospitals have been advised to “place urgent orders for the unlicensed import of salbutamol nebulizer solution – do not wait until stocks are depleted before placing orders for import.”
The drug is administered through a nebulizer, which pushes air through the liquid and creates a mist that relaxes the patient’s muscles and reopens the airways.
The Guardian revealed in January that drug shortages in Britain were reaching record levels, prompting doctors to fear that patients’ lives could be at risk.
A specialist pulmonologist who routinely uses mists of the drug when patients can no longer breathe unaided said: “This is worrying. This is a life-saving drug that is the basic medicine we use when patients with severe respiratory problems feel acutely unwell.
“We are being asked to ration it, and where possible, not to use it and use alternatives. We have been advised to use it sparingly – only when absolutely necessary. This is not a crisis right now. But it is a concern that a life-saving drug has to be rationed.”
The patient safety alert also told hospital bosses that to save supplies for use in the most serious cases, doctors should do the following:
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Have all patients wean off nebulizers once their condition has stabilized.
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Consider discontinuing nebulizer use in patients experiencing a mild to moderate asthma attack or COPD flare-up and using a salbutamol metered dose inhaler (pMDI) instead.
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When a patient requires nebulizer fluids, use them “as needed, rather than regularly.”
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As far as possible, facilities should only be used for ‘acute, severe exacerbations of COPD and asthma’, people who cannot breathe due to an attack of anaphylaxis – a life-threatening allergic reaction to eating something – and those who cannot take pMDI.
The shortage will not affect the availability of salbutamol inhalers, the blue-colored ‘reliever’ inhalers that patients with lung conditions such as asthma use when they become short of breath.
The shortage only concerns mists or bottles of liquid salbutamol, which are sold under various brand names, including Ventolin. Patients are given a salbutamol nebulizer when repeated inhalation of the drug through a tube has not helped them regain their ability to breathe independently.
Doctors expressed concern about the situation. Dr. Tim Cooksley, former president of the Society for Acute Medicine, said: “Salbutamol is often used to treat acutely ill medical patients with breathing problems and there is no off-the-shelf alternative. It is an important part of daily practice and there is a risk of significant harm to these patients if the supply issues are not resolved quickly.”
The charity Asthma and Lung UK posted on its website patients report that “supplies of salbutamol nebulizer are currently limited in the UK”.
It said: “There are alternatives available that healthcare professionals can prescribe.” In addition, “nebulizer fluid from other countries with similarly high licensing standards to Great Britain will also be made available.”
The DHSC claimed the shortage had ended after it arranged alternative supplies.
An NHS spokesperson said: “The recent short-term disruption to the supply of salbutamol nebulizer has now been resolved. This was caused by one supplier experiencing a production problem. The department quickly engaged with suppliers and others in the supply chain to ensure supplies were available for UK patients.”