No, for once this isn’t personal.
I was reading a comment from a GP today, in which he claimed, without any major indication of loose slates or irony, that a patient with well-controlled asthma would need to use a Salbutamol (Ventolin), inhaler only once or twice a week.
This guy is so mind-bogglingly inept I will happily offer prayers to a non-existent god that he’s not my GP. “Clueless bastard” doesn’t begin to describe this guy. If any asthmatic truly needs Salbutamol once or twice a week, I would venture to suggest that their asthma isn’t merely well-controlled, it’s actually pretty minimal to begin with. That or their quality of life, thanks to the restrictions placed upon their Salbutamol use, is absolutely abysmal. A GP with this attitude to healthcare rationing is dangerous.
What’s that? I’m over-reacting? Not in the slightest, I’m a lifelong asthmatic whose asthma became controlled enough for me to lead an extremely active life mainly because of Salbutamol (and later, thanks to the introduction of Phyllocontin Continus).
The instructions for Salbutamol are clear; it should be used as required, it’s a reliever, not a preventer and, just as you can get breakthrough pain with analgesics, you can get breakthrough asthma attacks no matter how good the preventer meds.
Until very recently – though my asthma has metamorphosed into COPD – I would use my Salbutamol inhaler up to a dozen times a day (I also have bronchiectasis, which complicates matters), and back in my rambling and backpacking days, Salbutamol would also be used as a prophylactic (taken before activity), which the literature supports. How much I used it when active I really don’t know – I just ordered more when it was needed. If I’d had a GP who restricted me to once or twice a week, I might well have died doing what I did. Or, of course, led a seriously piss-poor life. Even now, when my level of activity is profoundly restricted, there are many days when I need 10 or more squirts of the stuff – I’m rather attached to being able to breathe.
Salbutamol is a cheap drug, it’s extremely efficacious, and its use should NOT be restricted – the only person who knows if they need it, is the patient. OK, spirometry would indicate if the need is genuine, which is absolutely no help when, for example, I’m clinging to Wetherlam Edge by my eyebrows – my lungs, Dr, Numbnuts, my call. Anyway, you can’t monitor a patient every time his/her breathing shuts down and they need a squirt of Salbutamol – it’s a ludicrous idea – you have to trust the patient – they, Doc, have more experience of their illness than you have. They live with it on an hour by hour, day by day, basis.
About 20 years ago, when I was assessed at the Pulmonary Function Laboratory, I was told, quite firmly, that I should take my Ventolin inhaler as often as I felt the need – it’s quite impossible, I was assured, to over-dose on the aerosol inhaler, even if I took the whole thing. And, in hospital, I routinely get huge doses, delivered via a nebuliser, which bears out that opinion.
Dr. Numbnuts also says “…salbutamol IS NOT a disease modifying drug…” which is bullshit, True, it will not modify in the slightest the progress of the disease, but that is 100% not the point. The point – the ONLY point for the patient – is that it modifies the experience of the disease, makes it easier to live with, and enables the patient to breathe better. That’s what it’s designed to do, and that’s what it does, very well indeed. And that, if you’re an asthmatic patient, not a penny-pinching tosser of a GP, is invaluable.
Once or twice a week my arse!