Asthma sufferers in the UAE who rely on Ventolin to relieve symptoms are struggling to refill their medication, with many pharmacies reporting they have not had inhalers in stock for more than a month and have little information when more will be delivered.
Salbutamol, also known as albuterol, is most commonly sold under the brand name Ventolin, manufactured by GlaxoSmithKline. It is a treatment for asthma sufferers that opens up the medium and large airways in the lungs.
The shortage is believed to have been caused by high demand triggered by a surge in seasonal respiratory diseases, brand popularity and overprescription.
Omer Maqsood, a pharmacist with BinSina Pharmacy, said the branch he manages in Umm Suqeim 1 has been out of stock for more than a month. "I have no idea when we might get more," he told The National. He said this was the first time he has seen the product go out of stock for more than two years.
Only around ten of BinSina’s more than 100 UAE outlets had one or two inhalers available, with all branches in Oman showing as out of stock, according to Mr Maqsood. The National also contacted Life Pharmacy, which has more than 460 outlets in the Emirates, and only one store in Deira had three in stock, they said.
Dr Rachel Kaminski, a consultant pulmonologist and head of department at Saudi German Hospital in Dubai, said the hospital had also recently run out but was able to restock. She believes a "massive" over-reliance on Ventolin inhalers in the UAE has led to the shortage. "There has also recently been a rise in viral infections, with flare-ups of under-diagnosed asthma."
Tackling asthma care in the UAE
Asthma is one of the most common chronic non-communicable diseases, affecting more than 260 million people globally, and is responsible for more than 450,000 deaths a year. Most of these deaths are preventable, but according to the Global Initiative for Asthma, they are not prevented due to lack of availability or the high cost of inhaled medicines.
Uncontrolled asthma is prevalent in the Middle East, according to a report published by the International Journal of Emergency Medicine in November. This came after a discussion on the current gaps in post-discharge asthma management in the UAE by a joint task force of experts from the Emirates Society of Emergency Medicine and Emirates Thoracic Society.
Dr Kaminski said one of the biggest problems is that doctors here are quick to prescribe a Ventolin inhaler to anyone struggling with respiratory issues, but that it should not be the first line of treatment unless it is an emergency.
There are two types of inhalers. One prevents asthma attacks and should be used every day to control inflammation and swelling in the airways. The other is a reliever, like Ventolin, which is used to relieve symptoms.
The more patients use a reliever, the more they need it, and a major UK study of asthma deaths, known as the National Review of Asthma Deaths 2014, directly links overuse of inhalers like Ventolin to an increased risk of death from asthma. The study looked at patient data from hospitals and GP practices over 10 years and found people using their reliever inhaler three times a week or more, or needing more than 12 reliever inhalers in a year, have asthma that is not well-controlled.
Demand for Ventolin in UAE
Mr Maqsood said he has seen a lot of demand for Ventolin inhalers, particularly recently with seasonal viruses. "It's very common because it's very famous and it has been known on the market for so long that everyone knows that name and it's available over the counter."
Many medications go out of stock around flu season, when there's a change in the weather or around public holidays, when people tend to travel overseas. "Panadol sometimes goes out of stock because of overconsumption," he added.
Other medications go out of stock because the manufacturer is making a change, he added. Otrivin nasal decongestant recently ran out because the packaging altered, for example.
Preventive alternatives
This high demand for Ventolin is also linked to a shortage of preventive alternatives as pharmacies prioritise buying larger stocks of the reliever inhaler. An example of this is Trelegy, which Dr Kaminski said is one of the best treatments on the market for asthma.
"It's a very modern inhaler and has long-acting molecules in it. There was a supply issue for a while mainly because pharmacies weren't ordering it in, letting it run out and then getting it in stock after the fact."
Mr Maqsood, who said the Trelegy inhaler is not available at his store, confirmed this. "It's not as common here, so it won't be available in full quantity. They will buy low stock as they don't want it to go out of date when it's not popular," he said.
One asthma sufferer who has been affected by the lack of Trelegy on the market is business owner Ananda Shakespeare. She was diagnosed in May 2023 after being dismissed for months by doctors who sent her home with cough medicine.
"I said I was coughing so much I thought I was dying, but he didn't take me seriously," she said. "By that point, I wouldn't go anywhere without water or cough sweets. I'd avoid social occasions, Zoom calls and face-to-face meetings in case I had coughing fits."
After four months, she went to Dr Kaminski for a second opinion. She quickly diagnosed a rare respiratory condition called cough-variant asthma, and prescribed Trelegy. "Ever since then it’s been plain sailing," she told The National. "I only need one puff a day of Trelegy and that’s all it takes to keep me from having any symptoms."
It can be hard to find outside of the prescribing hospital, however, she confirmed. "I have trouble buying it if I walk into a pharmacy sometimes … I have run out of it twice and been without an inhaler for a week to 10 days," she said. With this preventive treatment, however, it takes Ms Shakespeare about six days to experience symptoms.
What to do if you have poorly controlled asthma?
Dr Kaminski advised anyone who needs a Ventolin inhaler more than twice a week and has any symptoms at night to get a proper review from a doctor. "Anyone who needs this, or anyone using a nebuliser as well, needs to find out what we're actually treating here," she added. "You need to treat the underlying cause with a long-acting inhaler."
There is an over-reliance on steroids for treatment of asthma as well, she added. "These medications will get them better for a few days, but it's not a long-term treatment. For an acute asthma attack, Ventolin is amazing to keep you alive, but if you need it as a baseline, then you need to look further."
