Alternative nebule products are available and can be reimbursed under existing community drug schemes.

If you are having difficulty accessing your prescribed nebules, please speak to your pharmacist.

While these shortages last, temporary arrangements are in place:

• If you have a Medical Card, your pharmacist can apply for reimbursement under the Discretionary Hardship Arrangements.
• If you are registered for the Drugs Payment Scheme (DPS), alternative products are supported under that.
• If you are not currently registered for a Medical Card or the DPS and think you may be eligible, your pharmacist or GP can advise you on how to apply.

As participation in certain reimbursement arrangements may vary between community pharmacies and local health regions, patients are encouraged to speak with their pharmacist, who can advise on the most appropriate options available locally.

Nebulised salbutamol remains an important treatment in severe or life-threatening asthma attacks. However, it is important to remember that, when used correctly, ten puffs of a blue reliever inhaler delivered one puff at a time through a spacer can provide a similar effect to a standard nebuliser dose.

Nebulisers should only be used at home under medical guidance, as inappropriate use may mask worsening symptoms and delay access to emergency care.

The Asthma Society encourages all people with asthma and their caregivers to be confident in using a spacer device correctly. Done properly, this technique is highly effective and can save lives.

Please find a video demonstrating this technique here.

The study represents a major breakthrough after 50 years without significant treatment advances. Currently the standard treatment for asthma exacerbations are steroid tablets, which the Asthma Society’s recent campaign highlighted, are associated with a heightened risk of mood disorders, diabetes, glaucoma and osteoporosis, among other possible side effects. While larger trials are still needed, this therapy offers hope for more effective, safer treatments for millions of patients worldwide.

“This landmark study gives us renewed hope that as asthma and COPD specialists, we may very soon to able to offer a large subgroup of asthma patients a new alternative to traditional steroid tablets in the treatment of serious and life-threatening forms of asthma attacks who have easy-to-detect evidence of eosinophilic flare-ups of their disease. A simple blood test in the emergency department could see if this drug is the best option for them. Larger confirmatory studies and careful cost-benefit analyses are awaited but there is real hope that this is a game-changer for how we treat eosinophil asthma and eosinophilic COPD flare-ups.” Dr Marcus Butler, Medical Director, Asthma Society of Ireland

This announcement comes in the same week as the release of our new report, Towards Optimal Severe Asthma Care. The report follows an in-depth investigation into severe asthma care in Ireland and highlights the devastating impact the disease can have on people’s lives. One of the key recommendations in the report is an increase in the allocated funding for biologic treatments, of which Benralizumab is one.

Read the report here.

It is important to be aware of potential, uncommon behavioural and mental health/mood disturbances that have been known to occur in a small number of patients on montelukast (known to occur in adults, adolescents and children), and which are highlighted in the patient information leaflet found in the packaging for this medication.

“While we wholly understand the concerns about the recent coverage of montelukast and its potential side effects in children, we urge parents not to make sudden changes to their child’s medication without first consulting their doctor. Doctors are best placed to advise parents on medication and their side effects and can support you and your child to manage their asthma more effectively and safely.” Dr Marcus Butler, Medical Director – Asthma Society of Ireland

Side effects can include agitation and aggressive behaviour or hostility and depression. Very rare instances (up to 1 in 10,000 people) of hallucinations, disorientation, suicidal thoughts and self-harm actions have been reported to authorities. Whilst montelukast has been known to cause or exacerbate mental health issues in some children, it should be noted that every child responds to medication uniquely and, for many, montelukast remains an extremely important and powerful tool in improving asthma control.

For some patients with asthma, montelukast uniquely treats abnormalities in the lung windpipes that other asthma medications haven’t helped (there are other asthma patients who get no benefit from montelukast). It can improve children’s quality of life greatly and reduce the need for oral steroids and even hospitalisation.

If you are concerned about your child’s medication or have questions about side effects, you should speak to your child’s doctor about potential alternatives.

It is extremely important to speak to your child’s doctor before changing or discontinuing asthma medications, as there can be unintended consequences to stopping montelukast, such as an asthma attack.

The Asthma Society of Ireland operates a free Adviceline and WhatsApp messaging service for people with asthma and their carers. This service operates 9am-5pm Monday-Friday and allows you to receive support from our team of expert nurses.

• Asthma Adviceline: 1800 44 54 64
• WhatsApp message: 086 059 0132