Patient safety alert warns of salbutamol nebuliser liquid shortages with no date for resupply

Pharmacy teams have been told to “urgently” order unlicensed imports of salbutamol nebuliser liquid because of a shortage with no resolution date.

A patient safety alert, issued on 26 February 2024, warns that 2.5mg/2.5mL and 5mg/2.5mL units of nebuliser liquid are in shortage, and says that, while terbutaline, salbutamol with ipratropium, and ipratropium nebuliser liquids remain available, “they cannot support an increase in demand”.

It also says that Ventolin (salbutamol; GSK) 5mg/mL nebuliser liquid is out of stock until mid-April 2024 and “cannot support an increased demand after this date”.

The alert says that all NHS providers should “liaise with local pharmacy teams and place urgent orders for unlicensed imports of salbutamol nebuliser liquid”.

“Do not wait for supplies to be exhausted before placing orders for imports,” it adds.

It also states that all patients should be weaned off nebulisers as soon as their condition has stabilised, and adds that clinicians “should consider use of high-dose salbutamol pressurised metered-dose inhaler via a large volume spacer in patients with mild to moderate asthma attacks or [chronic obstructive pulmonary disease], ensuring the patient is issued with a new inhaler to avoid risk of using a near empty device”.

The safety alert says that the shortages have been caused by “a combination of manufacturing issues resulting in increased demand on other suppliers” and adds that supplies of licensed salbutamol nebuliser liquid have been allocated for ambulance services that cannot administer unlicensed medicines via patient group directions.

Anna Murphy, consultant respiratory pharmacist at the University Hospitals of Leicester NHS Trust, said that her trust was experiencing shortages in salbutamol nebuliser liquid and buying unlicensed versions, but there was a delay in receiving that stock.

Commenting on the safety alert, Murphy said: “Salbutamol administered via a nebuliser is generally over used in clinical practice.

“National and local guidelines should be followed strictly to ensure the stocks available are used appropriately to patients with severe bronchoconstriction.

“Patients will need support to understand the limited role of nebulised salbutamol in their treatment regimen and to understand that handheld devices — for example, a metered-dose inhaler with a spacer — with optimal inhaler technique deliver the equivalent pharmacologically to the airways.”