Salbutamol nebule shortage: what to do if you use a nebuliser for asthma

What just happened

If you or someone in your household uses a nebuliser to deliver salbutamol for asthma, this is a supply notice worth reading now.

GSK has confirmed a national shortage of Ventolin Nebules — the salbutamol sulfate liquid ampoules used in electric nebuliser machines. The 2.5 mg/2.5 mL ampoules are expected to remain in limited supply until 21 December 2026. The 5 mg/2.5 mL ampoules are expected to ease around 17 August 2026.

The shortage affects the ampoules only. Pressurised metered-dose inhalers (pMDIs — the familiar blue puffer) are not affected. Salbutamol delivered this way remains available. Neither the TGA medicine shortages database nor the National Asthma Council expects a supply gap in salbutamol itself — the issue is specific to one delivery form.

This matters because some patients — particularly those with severe asthma, older adults, and young children who struggle with inhaler technique — rely on nebulisers as their standard delivery method. For them, the practical question is what to use instead between now and December.

Both-and

A pMDI and spacer is a genuine clinical equivalent

The evidence base on this is solid. A pressurised metered-dose inhaler with a correctly fitted spacer delivers at least equivalent bronchodilation to a nebuliser for adults and children, including during symptomatic exacerbations. Clinical Associate Professor Debbie Rigby, clinical executive lead at the National Asthma Council, is direct: “Pressurised metered-dose inhalers with a spacer are at least as effective as a nebuliser for the delivery of salbutamol for adults and children, even during symptomatic exacerbations.”

It is also faster. A full dose of salbutamol via pMDI takes a few minutes; nebuliser delivery typically takes up to 10 minutes per dose. For someone in the middle of an exacerbation, that time difference is not trivial.

Spacer technique matters. A spacer that fits the pMDI correctly and is cleaned regularly performs consistently; one that leaks, fits poorly, or has static build-up (common in older plastic spacers) delivers less medication than intended. If the spacer in your cupboard is old, cracked, or has visible static discolouration on the inside, it is worth replacing before the situation becomes urgent. Your pharmacist can advise on the right spacer for your inhaler.

This shortage surfaces a broader conversation

The updated Australian Asthma Handbook has moved away from short-acting beta2 agonist (SABA) monotherapy as a standard approach for adults and adolescents. The current evidence base supports anti-inflammatory reliever (AIR-only) therapy and maintenance-and-reliever therapy (MART) as the preferred approaches for most people with persistent symptoms — because they address the underlying airway inflammation, not just the bronchospasm on top of it.

A/Prof Rigby put it plainly in the National Asthma Council statement: “No adult or adolescent should be using SABA-only treatment. The emphasis is now on embedding anti-inflammatory reliever and maintenance-and-reliever therapy approaches as standard care.”

For many people, this will be the first time they have heard that their blue puffer is no longer considered a standalone treatment plan. That is a significant message, and it deserves a proper conversation with a GP or pharmacist rather than a brief read of a supply notice.

The hold-both: the SABA-only limitation is real, grounded in trials, and has been building in the guidelines for years. But the transition to AIR or MART involves a different inhaler technique, often a different device, and sometimes a different cost structure — changes that need to be explained, not just issued. The shortage creates a practical forcing function, and some people will receive that message under pressure rather than in a calm review consultation. The care system works better when this conversation happens proactively.

Who is most affected by this shortage

Nebuliser use in Australia is concentrated in a few groups: people with severe asthma who have been unable to achieve control with inhalers alone, older adults whose inhaler technique has deteriorated, children too young for reliable inhaler coordination, and some people living in residential care settings where nebulisers have become institutional habit rather than clinical necessity.

For most adults using a nebuliser for routine asthma management, the shift to a pMDI with a spacer is achievable with brief instruction and a spacer review. For the subset with genuinely severe disease where nebuliser delivery has been clinically indicated rather than habitual, the conversation with a respiratory physician about alternatives is more complex and may involve compounding or hospital access arrangements. That conversation should happen before December rather than during an exacerbation.

My two cents

If you or your child uses salbutamol nebules regularly: the practical step this week is a conversation with your pharmacist or GP about using a pMDI with a spacer as the primary delivery method until supply is restored. Take your spacer to the consultation — have them check the fit and technique before you need it in an emergency.

If you have a longstanding asthma management plan that centres on a nebuliser as the main reliever device, this is also a reasonable moment to ask your GP whether your current plan aligns with the updated Australian Asthma Handbook guidance on AIR and MART approaches. Not because the shortage mandates it, but because the guideline shift has been underway for a while and the shortage makes the conversation timely.

If you are managing an infant or young child with asthma — and spacer technique is already part of your routine — the shortage is unlikely to affect you directly. The nebule shortage does not affect the pMDI or spacer availability your child’s plan already relies on.

Verdict: yes — if you use salbutamol nebules, this is an urgent supply notice. Confirm your pMDI and spacer are current and your technique is sound before supply becomes critically tight.

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Sources cited

1. Salbutamol nebules shortage update for health professionals. National Asthma Council Australia, July 2026. https://www.nationalasthma.org.au/news/2026/salbutamol-nebules-shortage-update-for-health-professionals
2. Medicine shortage reports database. Therapeutic Goods Administration. https://www.tga.gov.au/products/medicines/medicine-shortages/medicine-shortage-reports-database
3. Australian Asthma Handbook. National Asthma Council Australia. https://www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/handbooks/asthma-handbook