What could possibly be right about getting Ventolin EVERY week?!

Ventolin HFA, a rescue inhaler, aka albuterol inhaler, is often overused to improve breathing in people with various conditions, ranging from asthma to COPD (chronic obstructive pulmonary disease possibly due to smoking) to allergies to difficulty breathing while fighting off a cold.

Ms. Ventolin, and advanced stage COPD'r, had been telling us that she needed her inhaler refilled every week. Somehow her doctor must have agreed because she had a prescription for #4 inhalers with a year of refills. Well, according to the directions provided on the prescription, 200 puffs of Ventolin should have lasted 25 days--which is a lot longer than a week. However, the prescriber had been contacted by other pharmacists in the past and still approved the fill. Notably, there was a recent prescription for Advair, however, Ms. Ventolin had told us the Advair was "not helping, so she stopped it."

Since I have been working nights a lot, it was difficult for me to call and catch a doctor, so I started out by contacting the doctor-on-call the first night I decided to seriously tackle this issue, although I had sent a fax about a week earlier, which was ignored. The doctor-on-call was semi helpful, encouraged me to contact the patient's prescriber by fax with details on his filling history, and request another med. After a week of back-and-forth faxing and looking for alternatives her insurance would cover, we finally hit the jackpot last Friday and provided Ms. Ventolin with her new Symbicort inhaler twice a day.

Three days later I met Ms. Ventolin at the pharmacy counter. Apparently, the new inhaler has been working beautifully! Ms. Ventolin is feeling better and only using her Ventolin twice a day!!! (That's a reduction of about 30 puffs a day, but who's counting?) Plus she has been able to cut out the frequent albuterol nebulizations and save a boat-load of cash not by having to buy inhalers when the insurance said the claim was too early to fill (in spite of the way the prescription was written).

Now that's why I went to pharmacy school. To me, it is a reminder that if I'm ever too busy to help a patient in this kind of situation, I need to hang up my white coat and go be a cashier.