Strategies to conserve salbutamol pressurized metered-dose inhaler stock levels amid COVID-19 drug shortage
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CURRENT OPINION
Strategies to conserve salbutamol pressurized metered‑dose inhaler stock levels amid COVID‑19 drug shortage Ali Elbeddini1 · Yasamin Tayefehchamani2 · Lucy Yang3
© Springer Nature Switzerland AG 2020
Abstract Essential inhaler medications for patients with respiratory diseases are backordered due to the coronavirus disease of 2019 (COVID-19). In hospitals, there has been a drastic increase in the use of salbutamol pressurized metered-dose inhalers (pMDIs), as well as salbutamol Diskus, leading to a decline in availability and causing interruptions in the supply chain. Patients with asthma are at higher risk of respiratory complications if they are infected with COVID-19. Salbutamol, a short-acting β-agonist (SABA), could be a life-saving medication during critical conditions. Other short-acting muscarinic antagonists (SAMAs), such as ipratropium pMDI, and combinations of SABA/SAMA, such as Combivent Respimat, are also starting to have supply issues. With the ongoing pandemic, hospitals need to consider conservation strategies to facilitate resource-efficient salbutamol delivery and reduce their waste. In this current opinion, we demonstrate several strategies for avoiding pMDI wastage that can be adopted in both the hospital and community settings. These strategies include reprocessing used or expired pMDIs, using intravenous salbutamol and other short acting inhalers when available, and prescribing maintenance inhalers to prevent over usage of salbutamol pMDIs. We also highlight the important role of physicians and pharmacists in optimizing medication therapies to ensure adequate supplies.
Salbutamol drug shortage As hospitalization rates increase due to the spread of coronavirus disease 2019 (COVID-19), salbutamol has become the first line of defense for COVID-19 patients with respiratory distress in the emergency room [1]. Special populations, such as elderly patients with asthma or chronic obstructive pulmonary disease (COPD) and premature infants with compromised lungs due to the respiratory syncytial virus, rely heavily on salbutamol pressurized metered-dose inhalers (pMDIs). In addition, nebulization therapy, typically interchangeable with * Ali Elbeddini [email protected] Yasamin Tayefehchamani [email protected] Lucy Yang [email protected] 1
Winchester District Memorial Hospital, 566 Louise Street, Winchester, ON KK0C2K0, Canada
2
Leslie Dan faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
3
Medisystem Pharmacies, 75 Lesmill Road, Toronto, ON M3B 2T8, Canada
pMDI use, is not recommended in COVID-19 patients due to the risk of aerosolizing the virus and facilitating its spread [2]. Oral salbutamol (tablets and syrups) is not used for sudden breathing difficulties or asthma attacks. As a result, hospitals are seeing an increase in salbutamol pMDI use and supply has become limited. As a result of the current COVID-19 pandemic, salbutamol pMDIs, a staple therapy for millions of asthmatic and COPD patient
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