Patient safety spotlight: the risks of overprescribing Salbutamol inhalers for asthma

31 May 2022

Specialist inspectors have identified cases of Salbutamol inhaler overprescribing of up to six inhalers per prescription by online prescribers. In this article, co-produced by our CPhO Clinical Fellow Aileen O’Hare and Toby Capstick, Consultant Pharmacist Respiratory Medicine, we explore the risks of prescribing high volumes of Salbutamol inhalers. We highlight the need for ongoing patient monitoring, counselling advice, inhaler device choices and discuss the clinical considerations when continuing treatment.

Clinical guidance

The information below outlines best practice guidance for the prescribing of salbutamol inhalers and what clinical history, signs, symptoms and monitoring prescribers should consider when initiating salbutamol prescriptions or continuing treatment on a long-term basis.

We also want to highlight that the risk of severe exacerbations and mortality increase incrementally with higher short acting beta agonist (SABA) use.

GPhC standards and guidance

In practice: Guidance for pharmacist prescribers [PDF 896.66 KB] recommends safeguards for the online prescribing of certain medicines. It highlights that some categories of medicines are not suitable to be prescribed or supplied at a distance unless further safeguards have been put in place to make sure that they are clinically appropriate. The categories include: Medicines that require ongoing monitoring or management. For example: medicines with a narrow therapeutic index, such as lithium and warfarin; and medicines used to treat diabetes, asthma, epilepsy, and mental health conditions. 

The guidance also recommends safeguards are put in place if the above categories of medicines are to be supplied online. If a pharmacist prescriber decides to prescribe at a distance or work with an online prescribing service, the above categories of medicines should not be prescribed unless the prescriber has contacted the GP in before issuing a prescription for medicines which are liable to abuse, overuse or misuse (or where there is a risk of addiction and ongoing monitoring is important) and the GP has confirmed to the prescriber that the prescription is appropriate for the person, and that appropriate monitoring is in place.

The standards for pharmacy professionals highlight that pharmacy professionals should provide person centred care, work in partnership with others, communicate effectively, maintain, develop and use their professional knowledge and skills, and use their professional judgement.

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