Asthma clinics - are they really mandatory?

[oldbanger]

I've been an asthmatic for more than 3 decades. It's mild asthma and controlled with the occasional dose of salbutamol. I consistently provide a peak flow of well above that expected for an asthmatic of my build, and around the average for a non-asthmatic. All in all I'm happy with the way it's controlled and when I've had any reviews it's been a formality.

I have just had to drive 30 miles to the nearest post office depot to get a recorded delivery letter from my doctors telling me that I'm not allowed to have any more medication unless I attend their asthma clinic and see a nurse. I make sure I turn up for an annual medication review with my GP and am not due for another one until September - that's enough hassle as the surgery doesn't open until after I start work and shuts before I get home again. The asthma clinic is in the middle of the day, requiring a whole day off work - unpaid most likely as I'm a bit tight on annual leave once things like school sports days etc are covered.

What miffs me is that I know this is a QOF box ticking exercise. I'm not able to move practice as the only other local one is the other branch of the same practice (teach me for living in a village). I'll last a few months before I run out, even with my current chest infection. Is it really mandatory, or are they just making up their own rules?

<-- Grump

[Stevenj214]

Not sure if there are different rules south of the border but when I registered with my new GP and explained I use my salbutamol inhaler infrequently, he set up a repeat prescription and told me I can get it whenever I need some.

[oldbanger]

Yes, this has been my arrangement. Except to qualify for repeat scripts you had to see a GP once a year.

They clearly don't get enough work ...

[Ordinary_Chap]

oldbanger said:

I've been an asthmatic for more than 3 decades. It's mild asthma and controlled with the occasional dose of salbutamol. I consistently provide a peak flow of well above that expected for an asthmatic of my build, and around the average for a non-asthmatic. All in all I'm happy with the way it's controlled and when I've had any reviews it's been a formality.

I have just had to drive 30 miles to the nearest post office depot to get a recorded delivery letter from my doctors telling me that I'm not allowed to have any more medication unless I attend their asthma clinic and see a nurse. I make sure I turn up for an annual medication review with my GP and am not due for another one until September - that's enough hassle as the surgery doesn't open until after I start work and shuts before I get home again. The asthma clinic is in the middle of the day, requiring a whole day off work - unpaid most likely as I'm a bit tight on annual leave once things like school sports days etc are covered.

What miffs me is that I know this is a QOF box ticking exercise. I'm not able to move practice as the only other local one is the other branch of the same practice (teach me for living in a village). I'll last a few months before I run out, even with my current chest infection. Is it really mandatory, or are they just making up their own rules?

<-- Grump

I have to do this all of the time and I can blow the peak flow meter off the scale!

I use salbutamol because I'm allergic to a lot of things and asthma can come on quickly so I like to have one in the car and coat. I don't mind too much as I've tried other solutions because salbutamol is pretty bad for the lungs over the long term.

I actually think it is them doing their job in checking up on us and making us have the check up. I'd actually probably avoid it if it wasn't mandatory since I tend to take the approach of it will look after itself (which isn't particularly clever I know).

[oldbanger]

Other than stimulating excess mucous, I didn't think there were any long term side effects. I may be wrong however ... can you explain what it is you think the long term effects on the lungs are?

I've been on the stuff since I was 2

[DKL]

I'm something like 3 years overdue for an asthma clinic. Problem is they only tend to do them every 5th Friday when there's a P in the month for 20 mins!
I keep getting letters but I can't see how they can actually suspend my repeat prescriptions. Without them I would struggle a little but I'd be damned annoyed at them actually putting me in that situation.
Only problem I find is that they will only let me have one inhaler per prescription which at £7 odd each is a bit steep!

[gary71]

I'm several years over on mine

It's under control and as long as they do the scripts as requested I don't have a problem.

Forcing someone to endanger their health by not honouring a repeat prescription would be foolhardy in the extreme!

[gary71]

DKL said:

Only problem I find is that they will only let me have one inhaler per prescription which at £7 odd each is a bit steep!

Agreed. This winds me up.

Certain incurable medical conditions qualify for free prescriptions, but not us lot! Without prescriptions I would end up dead, or at least in A&E with disturbing regularity.

If you talk very nicely to your GP they can bump it up to 2x Inhaler per script. But you may have to go for an asthma review to get it

[DKL]

gary71 said:

If you talk very nicely to your GP they can bump it up to 2x Inhaler per script. But you may have to go for an asthma review to get it

I think that's the trade off!

[Ordinary_Chap]

oldbanger said:

Other than stimulating excess mucous, I didn't think there were any long term side effects. I may be wrong however ... can you explain what it is you think the long term effects on the lungs are?

I've been on the stuff since I was 2

Because it is steriod based I was told it will weaken lung response over time and the effects of the drug over a longer period also diminish.

Over what period and what degree is up for debate but either way it doesn't sound like a great long term solution.

[oldbanger]

Ordinary_Chap said:

Because it is steriod based I was told it will weaken lung response over time and the effects of the drug over a longer period also diminish.

Over what period and what degree is up for debate but either way it doesn't sound like a great long term solution.

salbutamol isn't steroid based, it's a beta-2-agonist - totally different beast

these types of drugs can be combined with steroids however e.g. exirel inhalors contained both pirbuterol and a corticosteroid (from dim and distant memory - the stuff gave me terrible tremors though)

Edited by oldbanger on Tuesday 12th June 23:31

[oldbanger]

gary71 said:

Agreed. This winds me up.

Certain incurable medical conditions qualify for free prescriptions, but not us lot! Without prescriptions I would end up dead, or at least in A&E with disturbing regularity.

If you talk very nicely to your GP they can bump it up to 2x Inhaler per script. But you may have to go for an asthma review to get it

My place won't do 2x inhalors even then... everywhere before this always did 2 inhalors, no questions asked. I always assumed that was because they were country doctors so lived by their own rules.

[vladcjelli]

oldbanger said:

gary71 said:

Agreed. This winds me up.

Certain incurable medical conditions qualify for free prescriptions, but not us lot! Without prescriptions I would end up dead, or at least in A&E with disturbing regularity.

If you talk very nicely to your GP they can bump it up to 2x Inhaler per script. But you may have to go for an asthma review to get it

My place won't do 2x inhalors even then... everywhere before this always did 2 inhalors, no questions asked. I always assumed that was because they were country doctors so lived by their own rules.

I've managed to get two inhalers per prescription for a while now. As far as I recall, doctors can prescribe any amount of a medication per prescription that they feel necessary.

Theoretically, this could mean that if you only need a checkup every year, you ought to be able to get enough inhalers to last you for that period. This will not happen.

If inhalers were available to buy in supermarkets like paracetamol, how much would they actually cost? Always feel a little bit screwed over having to pay an artificial price, but not sure what the real cost should be.

[Ordinary_Chap]

oldbanger said:

Ordinary_Chap said:

Because it is steriod based I was told it will weaken lung response over time and the effects of the drug over a longer period also diminish.

Over what period and what degree is up for debate but either way it doesn't sound like a great long term solution.

salbutamol isn't steroid based, it's a beta-2-agonist - totally different beast

these types of drugs can be combined with steroids however e.g. exirel inhalors contained both pirbuterol and a corticosteroid

Oh ok, thanks for straightening me out on that. I may have remembered the chat wrongly with the Dr it was a good few years ago.

Anyway I tried other inhalers on the Dr's recommendation however after moving around the country over a few years defaulted by the Salbutamol since it always worked for me.

[oldbanger]

vladcjelli said:

If inhalers were available to buy in supermarkets like paracetamol, how much would they actually cost? Always feel a little bit screwed over having to pay an artificial price, but not sure what the real cost should be.

I considered getting exirel once on private prescription, about (cough) 20 years ago now. It would have been £17 per pump. It was a fair bit more expensive than ventalin/salbutamol though.

[Jamie VTS]

Astmha costs me £15 per month! salbutamol sulphate and belcolmetasone dipropionate!

[merc_man]

The justification is to ensure your asthma is monitored regularly so they can detect any alarming changes. You might not notice an increasing reliance on your inhaler over time or a diminishing lung capacity but a yearly check up will. I'd rather do that and be advised on whether or not I need to increase the becotide than end up with emphysema.

Personally, it doesn't bother me. And if the cost of inhalers bothers you, buy a job lot when in France/Spain etc. On a recent trip I bought a couple of salbutamol inhalers in a Spanish pharmacy for 3 euros each.

[merc_man]

Jamie VTS said:

Astmha costs me £15 per month! salbutamol sulphate and belcolmetasone dipropionate!

Jamie, if that's the case you really need to consider prepayment certificates as that'll save you £76 a year.

[Jamie VTS]

merc_man said:

Jamie, if that's the case you really need to consider prepayment certificates as that'll save you £76 a year.

I was looking at that last night, it definately seems worth doing!

[BigTom85]

I agree, its frustrating. I probably use 2 inhalers a year, and have done for the past decade, so having to book a day off for what seems like a box-ticking check is annoying.