According to press reports, those diagnosed with asthma will soon be able to buy a reliever inhaler at supermarkets like Asda, without having to see a doctor first. Patients will be able to buy two commonly used blue inhalers (presumably salbutamol) under the guidance of a trained pharmacist and online GP service. The cost of this is reported to be slightly lower than the charge for a prescription.
It must be terrible for anyone to feel an asthma attack coming on, and experience the feeling of suffocation. In fact, from talking to patients, I appreciate that the stress of believing you are about to have an attack can make that attack inevitable. Having easy access to reliever inhalers, when you have forgotten to bring one with you, must surely, therefore, be a good thing?
I worry about this on a number of levels. Firstly, rates of adherence in asthma are very low; not for reliever inhalers, but for preventers. Relievers provide immediate, symptomatic relief; preventers need to be taken every day to prevent symptoms from developing. There is no immediate impact from taking a preventer; you don't feel anything. The result is that many patients manage their asthma by using relievers when they need to and don't take their preventers on a daily basis. Doctors can monitor patient control through assessing the frequency by which they ask for repeat prescriptions of reliever medication - too many prescriptions indicates a lack of control and should trigger a review. If patients have access to relievers outside the care of a physician, how can their control be monitored? And doesn't two relievers a month indicate lack of control? There is the potential for disease progression and subsequent impact on quality of life.
Secondly, I am concerned about the message this sends out to patients and to the broader public about asthma. It's not a particularly 'sexy' disease, for instance, you never see asthma sufferers in films or soap operas. Telling the public that medication is available in supermarkets implies that it is almost on a par with coughs and colds, it is not a serious condition which requires physician intervention and monitoring. Indeed, it seems to me that it almost becomes an acute disease, which you can easily treat. I am not a clinician, but surely this is wrong? Asthma is a chronic condition, which, when well-managed, allows patients to have a very high quality of life, but when not well controlled it can have a serious impact. According to Asthma UK, three people a day die from asthma, which is one person every eight hours; this isn't a condition which should be taken lightly.
I also worry about the path this is taking us down; what precedent does this set in the UK? Salbutamol is a prescription only drug, should it be available in this manner? Isn't that illegal? From the years of research I have done with patients, I never fail to be surprised at how many of them have no idea about the mechanism of action for the drugs they take. You could argue that this doesn't matter; I don't know how my mobile phone works, but I still use it. However, patients often tell me stories about a side effect issue which had a major impact on them, or how they make decisions not to follow their doctor's advice. The most shocking part of the story is always when they don't remember the name, or even the class, of drug they were telling me about.
Ultimately I do believe we need to consider alternative routes for access to medical care and management. However, is this the right way? The message this sends to patients and the general population risks exacerbating the issues of adherence in this condition. The response in terms of public perception and patient behaviour is something I'll be watching with interest.
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