NHS hospitals have been hit by a UK-wide shortage of a life-saving drug used to keep alive patients who are at risk of dying because they cannot breathe without medical intervention.
Doctors have been told to ration their use of the liquid form of salbutamol, which plays a vital 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 2.5mg and 5mg dose vials of salbutamol liquid are in short supply. The latter is “out of stock until mid-April 2024”.
The scarcity is so acute that hospitals were advised to “place urgent orders for unlicensed imports of salbutamol nebuliser liquid – do not wait for supplies to be exhausted before placing orders for imports”.
The drug is administered via a nebuliser, which pushes air through the liquid to create a mist that relaxes the patient’s muscles and reopens their airways.
The Guardian revealed in January that drug shortages in the UK were running at record levels, prompting fears among doctors that patients’ lives could be put at risk.
One specialist lung doctor who routinely uses nebules of the drug when patients can no longer breathe unaided said: “This is a worry. This is a life-saving drug that is the bread-and-butter medicine we use when patients with serious breathing problems are acutely unwell.
“We are being asked to ration it, and not to use it where possible and to use alternatives. We’ve been advised to use it sparingly – only if it’s absolutely essential. This isn’t a crisis at the moment. But it’s a worry that a life-saving drug is having to be rationed.”
The patient safety alert also told hospital bosses that in order to conserve supplies for use in the most serious cases, doctors should:
Wean all patients off nebulisers as soon as their condition has stabilised.
Consider no longer using nebuliser liquid for patients experiencing a mild to moderate asthma attack or flare-up of COPD and instead use a salbutamol pressurised metered-dose inhaler (pMDI).
When a patient does need nebuliser liquids, use them “when required rather than regularly”.
Supplies need to be used as far as possible only with “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 use a pMDI.
The shortage does not affect the availability of salbutamol inhalers, the blue-coloured “reliever” inhalers that patients with lung conditions such as asthma use if they develop shortness of breath.
The scarcity only involves nebules, or vials, of liquid salbutamol, which is sold under various brand names including Ventolin. Patients are put on a salbutamol nebuliser when repeated inhalation of the drug through a tube has not helped them regain their capacity to breathe independently.
Doctors voiced concern about the situation. Dr Tim Cooksley, the immediate past president of the Society for Acute Medicine, said: “Salbutamol is commonly used to treat acutely unwell medical patients with breathing problems and there is not a ready alternative to it. It is an important part of daily practice and there is a risk of significant harm to these patients if supply issues are not resolved quickly.”
The charity Asthma and Lung UK posted a message on its website telling patients that “the supply of salbutamol nebuliser liquid is currently limited in the UK”.
It said: “Alternatives are available that healthcare professionals will be able to prescribe.” In addition, “nebuliser liquid from other countries that have similar high standards of licensing to the UK will also be made available.”
The DHSC said the shortage had come to an end after it arranged alternative supplies.
A spokesperson said: “Recent short-term disruption to the supply of salbutamol nebuliser liquid has now been resolved. This was caused by one supplier experiencing a manufacturing issue. The department quickly engaged with suppliers and others in the supply chain to ensure supplies were available for UK patients.”
• This article was amended on 15 March 2024 to correctly attribute the final comment to a DHSC spokesperson, not an NHS spokesperson as an earlier version said.
