GPs urged to review asthma prescribing amid Ventolin nebule shortage

GPs have been informed of a supply shortage of Ventolin nebules which may impact their prescribing choices, however experts agree the shortage presents an opportunity to ensure patients are treated in line with national asthma guidelines.
 
Drug manufacturer GlaxoSmithKline Australia has notified of a supply shortage of Ventolin nebules (salbutamol sulfate) 5 mg/2.5 mL and 2.5 mg/2.5 mL inhalation solution ampoules ‘that may affect your ability to prescribe, administer or supply the products to your patients’.
 
The out-of-stock period for the 5 mg/2.5 mL inhalation solution ampoules is anticipated to last until 17 August 2026, while the 2.5 mg/2.5 mL ampoules are currently facing a supply shortage with limited availability until 21 December 2026.
 
The supply pressure has resulted from a continued shortage of non-GSK salbutamol 5 mg ampoules, the de-registration of non-GSK salbutamol 2.5 mg ampoules, an increase in patient demand for Ventolin-branded nebules, and limited scope to adjust manufacturing capacity to meet this demand, GSK explained.  
 
Clinical Associate Professor Debbie Rigby, Clinical Executive Lead at the National Asthma Council (NAC), said while this may be distressing for patients who have been using this medication, the shortage provides an opportunity for health professionals to reinforce the updated Australian Asthma Handbook guidelines.
 
‘No adult or adolescent should be using short-acting beta2 agonist (SABA-only) treatment and the emphasis is now on embedding anti-inflammatory reliever (AIR-only) and maintenance-and-reliever therapy (MART) approaches as standard care for adults and adolescents,’ she said.
 
Clinical Associate Professor Rigby said it is important for health professionals to communicate to patients that salbutamol delivered via nebuliser requires a higher dose without any added therapeutic benefit.
 
‘Pressurised metered-dose inhalers with a spacer is at least as effective as a nebuliser for the delivery of salbutamol for adults and children, even during symptomatic exacerbations,’ she said.
 
In addition, nebulisers are less portable as they may require a power source to run and take a longer time to deliver a dose of salbutamol, with patients needing to wait up to 10 minutes for the dose to be administered, according to the NAC. 
 
Clinical Associate Professor Rigby added that the recommendations to avoid SABA-only treatment and shift towards inhaled corticosteroids (ICS-containing) therapy for all adults and adolescents requires substantial education and behaviour changes for patients. 
 
‘We encourage all health professionals to talk to their patients about the importance of focusing on alleviating chronic inflammation in the airways, not just addressing symptoms,’ she said.
 
Chair of RACGP Specific Interests Respiratory Medicine Dr Kerry Hancock agrees that current supply concerns are a good prompt to review any patients relying on salbutamol to manage their asthma.
 
‘Most patients with asthma should not be using short-acting beta agonists, that’s salbutamol, for management of their asthma,’ she told newsGP.
 
‘This is an opportunity to review their asthma management and change patients over to treatment that is more aligned to the recently updated asthma management guidelines, where we’re trying to reduce the exposure to salbutamol.
 
‘Most patients, including even very young children, do not require nebulised Ventolin. They can be instructed in how to use salbutamol or Ventolin via a puffer and spacer.’
 
Dr Hancock added that this is not a shortage of pressurised metred-dose inhalers (pMDI) – only the nebules being used in nebulisers.
 
‘We have moved away from using those years ago in the community, because we know that using a puffer and spacer is just as effective and more suitable for patients than nebulised Ventolin.’
 
If a patient has an acute episode of asthma and requires salbutamol, Dr Hancock said it’s important to explore the reasons for this.
 
‘Why have they had this exacerbation, this acute asthma? Was the asthma not being managed appropriately or in in accordance with guidelines beforehand, and has resulted now in this exacerbation?’
 
Educating patients on the evidence is also an essential step in ensuring care is aligned with the latest clinical guidelines, Dr Hancock said.

To support patient understanding of why a medication regime might need to be changed, the National Asthma Council recently released a suite of resources to guide GPs and patients in their discussions.
 
The shortage announcement comes as the TGA registers a new medication option for severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps.
 
Depemokimab (sold as Exdensur) is an anti-interleukin-5 monoclonal antibody administered once every six months, prescribed by specialists under specific TGA criteria.
 
Dr Hancock said while there are other monoclonal antibodies on the market, this new medication might be more suitable for some patients given the twice-yearly dose, however this will be a decision for specialist colleagues.
 
GSK Australia Country Medical Director, Sebastian DiNatale, said the company looked forward to working with the Federal Government to support equitable access for Australians who may benefit from this treatment.
 
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