Sian Powell
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[post_content] => These case examples show that errors arise from system pressures, not individual failings. Pharmacists can act on these insights to strengthen governance.
When pharmacists call Pharmaceutical Defence Limited (PDL), they’re often navigating some of the most stressful moments of their professional lives.
Behind the scenes, PDL’s professional officers, including pharmacist Claire Bekema – who is also a professional practice pharmacist at PSA – talk pharmacists through clinical decisions, regulatory notifications and incident management.
Here, Ms Bekema outlines the top incidents reported to PDL, alongside practical strategies to reduce risk and respond safely when something goes wrong.
Wrong-patient supply leads to hospital admission
Wrong-patient incidents remain one of the most common and serious error types, often occurring when workflow pressures and assumptions collide.
‘That might be when you call out a script for “[one surname], and somebody just turns up and says, “Yep, that’s me,” and they take it out the door,’ Ms Bekema told participants of PSA’s Voices of Pharmacy – Passion, Purpose, and Possibility webinar last week (26 November).
In one case, which occurred after 60 Day Dispensing was implemented, a patient received two boxes of multiple medicines that were not theirs.
‘It was high-dose antihypertensives, and the patient had low health literacy, so they didn’t know what they were expecting to receive from the doctor,’ she said.
‘They picked up this other person’s medicines and they took one from each box. So they took really high doses of antihypertensives all at once.’
Once errors such as this are discovered, Ms Bekema is clear about what the next steps should be.
‘In this particular scenario, I said, “Let’s talk about the incident and how it occurred later, but the first thing is: try and track down this patient and make sure they’re receiving medical attention”,’ she said.
‘They ended up being transferred to hospital by ambulance because their blood pressure was [extremely low]. Wrong-patient errors can have pretty dire consequences.’
For more information, refer to previous AP coverage on:
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[post_content] => The Therapeutic Goods Administration (TGA) has today (Monday 1 December) made updates to product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists for two separate safety issues.
AP examines what pharmacists need to know.
ALERT 1: Potential risk of suicidal thoughts
The TGA has aligned product warnings for all GLP-1 RA medicines to ensure consistent information regarding the potential risk of suicidal thoughts or behaviours.
There have been growing questions about whether there’s a link between GLP-1 RAs and suicidal ideation. As of 23 September 2025, the TGA’s Database of Adverse Event Notifications (DAEN) contains the following:
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[post_content] => Australia’s east coast was belted with heavy storms last week. Spring and summer storms can trigger thunderstorm asthma – with bursts of pollen often causing sudden, severe asthma attacks, particularly in patients with asthma or allergic rhinitis.
‘There was the big event in Victoria in November 2016 when 10 people died,’ said Clinical Associate Professor Debbie Rigby FPS, pharmacist and Clinical Executive Lead, National Asthma Council Australia (NAC).
‘But there are other peaks that don’t get as much media coverage – for example, there was terrible weather on Melbourne Cup Day this year, and data showed there were over 100 emergency department (ED) admissions and ambulance callouts that day.’
When asthma symptoms spike, so do SABA (short-acting beta2-agonist) requests. With new guidelines that discourage overreliance on SABA, asthma expert A/Prof Rigby explains how pharmacists should manage these situations.
What do the new asthma guidelines say?
In the updated NAC Australian Asthma Handbook, released in September 2025, a key guideline change is that no adult or adolescent with asthma should be using salbutamol alone.
‘Every [adult or adolescent] with confirmed asthma now needs to be on an inhaled corticosteroid (ICS),’ A/Prof Rigby said.
The National Asthma Council recently released data that found there were 478 asthma-related deaths in 2024, equating to more than one per day.
There was a surprising increase in asthma deaths in the youngest patient cohort, those aged 0 to 35.
‘This is largely due to poorly controlled asthma, including people over-relying on SABA, not using preventers, or not using anti-inflammatory reliever therapy,’ Ms Rigby said. ‘Those with more severe symptoms should be on maintenance-and-reliever therapy, or MART.’
But that doesn't mean pharmacists should deny patients salbutamol, particularly during events such as storms that can trigger exacerbations.
‘Absolutely supply it if a patient has symptoms – it’s potentially life-saving during an acute episode – but we should be alluding to the fact that it’s risky to use salbutamol alone in asthma,’ she said. ‘‘Use it as an opportunity to explain that the guidelines have changed and that we now have better treatment, but also assess them to determine if they need to see a GP straightaway or go to ED.’
For example, if a patient can’t finish a sentence without taking a breath, they need immediate treatment.
Pharmacists should also remind patients that they should have an asthma action plan, which many adults don’t have. ‘Most people can manage with salbutamol in an acute situation – but they can also use budesonide-formoterol.’
It’s also important to point out the benefits of preventative and anti-inflammatory therapy, including improved asthma control and long-term health outcomes.
‘ICS–formoterol reduces the risk of severe episodes, it's more convenient because you only carry one inhaler and even has environmental benefits,’ A/Prof Rigby said. ‘There are about 15 million salbutamol inhalers used annually, which is a significant carbon footprint.’
What can pharmacists do?
A lot has been learned since the 2016 thunderstorm asthma event, A/Prof Rigby said.
‘The Victoria Department of Health has been very proactive with the pollen-alert apps that give daily high-pollen warnings,’ she said.
There are also similar systems in other states; these apps provide a daily alert using a traffic-light system across mapped regions.
‘For example [on Thursday], the Mildura area was “red” – very high pollen count,’ A/Prof Rigby said.
‘I encourage all pharmacists to sign up, but also to recommend them to patients with asthma and/or allergic rhinitis. When your area is on medium or high alert, pharmacists should be having conversations with patients about being prepared.’
This includes always having a reliever on hand – either salbutamol, or preferably, the anti-inflammatory reliever budesonide-formoterol.
‘During thunderstorm asthma – the “perfect storm” of high pollen plus thunderstorms – people should also avoid being outside, close windows, use air-conditioning, and in cars set air recirculation mode,’ she said.
And when patients present to the pharmacy for treatment for allergic rhinitis, pharmacists should ask: Do you have asthma?
‘Around 80% of people with asthma also have allergic rhinitis, and 40–60% of people with allergic rhinitis also have asthma,’ A/Prof Rigby said. ‘We need to think about “one airway, one disease.” If you get the nose under control, you get better asthma control – and vice versa.’
What’s the approach when it’s not asthma?
During the 2016 thunderstorm asthma event, many people who presented to pharmacies or EDs didn’t have diagnosed asthma, A/Prof Rigby said.
‘Many had hay fever or allergic rhinitis,’ she said. ‘So when people request hay fever treatments, pharmacists should ask about symptoms – such as shortness of breath, cough or chest tightness – which could indicate asthma.’
When these incidents occur, pharmacists should ask whether patients had childhood asthma, hay fever or other respiratory issues. They can also provide Asthma first aid.
‘You can supply a salbutamol puffer – ideally with a spacer – because when people are short of breath they’re less able to coordinate inhalation, and most people don’t use puffers correctly anyway,’ she said.
Pharmacists should use the 4x4x4 method: 4 puffs, one at a time, via a spacer; wait 4 minutes; repeat as needed.
‘If the patient is still short of breath, seek medical advice,’ A/Prof Rigby added. ‘And document everything.’
Pharmacists should also follow-up via phone, text or the next visit.
How should COPD be managed in a storm?
While asthma is reversible with good control, chronic obstructive pulmonary disease (COPD) involves persistent airway inflammation and irreversible obstruction.
Salbutamol may be used to relieve symptoms in patients with COPD, but it does not provide the same level of relief as it does in asthma, A/Prof Rigby said.
‘The perceived benefit of SABA for patients with COPD is often due to the person stopping and resting, or the anxiety relief of “doing something” – rather than actual bronchodilation,’ she said.
But patients with COPD are less likely to have their symptoms triggered by storms.
‘They may be short of breath at rest and have reduced exercise tolerance, so they must take preventative therapy regularly,’ A/Prof Rigby said.
This includes regular use of a long-acting muscarinic antagonist and long-acting beta2-agonist.
‘Only some patients need triple therapy,’ she added.
[post_title] => Severe spring storms show the risks of SABA overuse
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[post_content] => Allergic rhinitis (AR) remains a common but often underrecognised condition in Australian primary care1. Here’s what global experts shared at the 2025 FIP World Congress about how it should be managed.
With a prevalence of 23.9% in Australia,2 AR – commonly known as hay fever – significantly impacts patients’ quality of life, productivity, and often coexists with conditions such as asthma.3
The condition is caused by the nose and/or eyes coming into contact with allergens in the environment – such as pollens, dust mites, moulds and animal dander.2 When left untreated, AR can lead to complications including sleep disturbance, daytime tiredness, headaches, poor concentration, and recurrent ear or sinus infections.4
The role of pharmacists in AR management
Australian pharmacists play an increasingly vital role in the management of AR, supporting diagnostic differentiation, therapy optimisation and patient education in community settings.
Pharmacists can provide key interventions – including accurate symptom assessment, medicines recommendations and ongoing support for self-management.
Global updates: FIP 2025
At the 2025 FIP World Congress in Copenhagen, experts shared the latest evidence on AR management, highlighting innovations that can transform patient care. A key topic was the concept of antihistamines with 0% brain interference, such as fexofenadine. This antihistamine provides effective symptom relief without sedation, ensuring patients maintain cognitive performance and safety – critical for those operating machinery or driving.5
FIP President Paul Sinclair AM MPS, emphasised that pharmacists are uniquely positioned to lead AR management.
‘We know that people affected by AR can have their quality of life impacted quite dramatically, so it is important to intervene and recommend appropriate medication, which will relieve the symptoms and minimise the impact on somebody’s quality of life, so they can maintain all the things they need to do on a daily basis,’ he said
https://youtu.be/4no1XLK9TVs?si=dP-oEXSWEu_ohiJC
Watch on demand: 3rd Global Allergy Connect Meeting
Pharmacists in Australia can enhance their expertise in AR by accessing on-demand resources and lectures from the 2025 FIP World Congress. After registering with their professional details, pharmacists can view content from the 3rd Global Allergy Connect Meeting, where experts from the United Kingdom, Spain, and France discuss AR, antihistamines with 0% brain interference (such as fexofenadine), clinical evidence, and strategies for managing AR in community pharmacy settings.
For access:
References
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[post_content] => From mid-2027, the availability of dozens and dozens of complementary medicines containing vitamin B6 will change.
Yesterday (25 November 2025), the Therapeutic Goods Administration (TGA) released the final decision on the scheduling of vitamin B6 containing medicines in response to safety concerns following consideration of the advice of the Advisory Committee on Medicines Scheduling in November 2024 and public consultation.
What's changing?
The TGA Delegate’s final decision will see scheduling changes for products containing vitamin B6, dependent on the product’s vitamin B6 dose. This means oral preparations containing:
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[post_content] => These case examples show that errors arise from system pressures, not individual failings. Pharmacists can act on these insights to strengthen governance.
When pharmacists call Pharmaceutical Defence Limited (PDL), they’re often navigating some of the most stressful moments of their professional lives.
Behind the scenes, PDL’s professional officers, including pharmacist Claire Bekema – who is also a professional practice pharmacist at PSA – talk pharmacists through clinical decisions, regulatory notifications and incident management.
Here, Ms Bekema outlines the top incidents reported to PDL, alongside practical strategies to reduce risk and respond safely when something goes wrong.
Wrong-patient supply leads to hospital admission
Wrong-patient incidents remain one of the most common and serious error types, often occurring when workflow pressures and assumptions collide.
‘That might be when you call out a script for “[one surname], and somebody just turns up and says, “Yep, that’s me,” and they take it out the door,’ Ms Bekema told participants of PSA’s Voices of Pharmacy – Passion, Purpose, and Possibility webinar last week (26 November).
In one case, which occurred after 60 Day Dispensing was implemented, a patient received two boxes of multiple medicines that were not theirs.
‘It was high-dose antihypertensives, and the patient had low health literacy, so they didn’t know what they were expecting to receive from the doctor,’ she said.
‘They picked up this other person’s medicines and they took one from each box. So they took really high doses of antihypertensives all at once.’
Once errors such as this are discovered, Ms Bekema is clear about what the next steps should be.
‘In this particular scenario, I said, “Let’s talk about the incident and how it occurred later, but the first thing is: try and track down this patient and make sure they’re receiving medical attention”,’ she said.
‘They ended up being transferred to hospital by ambulance because their blood pressure was [extremely low]. Wrong-patient errors can have pretty dire consequences.’
For more information, refer to previous AP coverage on:
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[post_content] => The Therapeutic Goods Administration (TGA) has today (Monday 1 December) made updates to product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists for two separate safety issues.
AP examines what pharmacists need to know.
ALERT 1: Potential risk of suicidal thoughts
The TGA has aligned product warnings for all GLP-1 RA medicines to ensure consistent information regarding the potential risk of suicidal thoughts or behaviours.
There have been growing questions about whether there’s a link between GLP-1 RAs and suicidal ideation. As of 23 September 2025, the TGA’s Database of Adverse Event Notifications (DAEN) contains the following:
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[post_content] => Australia’s east coast was belted with heavy storms last week. Spring and summer storms can trigger thunderstorm asthma – with bursts of pollen often causing sudden, severe asthma attacks, particularly in patients with asthma or allergic rhinitis.
‘There was the big event in Victoria in November 2016 when 10 people died,’ said Clinical Associate Professor Debbie Rigby FPS, pharmacist and Clinical Executive Lead, National Asthma Council Australia (NAC).
‘But there are other peaks that don’t get as much media coverage – for example, there was terrible weather on Melbourne Cup Day this year, and data showed there were over 100 emergency department (ED) admissions and ambulance callouts that day.’
When asthma symptoms spike, so do SABA (short-acting beta2-agonist) requests. With new guidelines that discourage overreliance on SABA, asthma expert A/Prof Rigby explains how pharmacists should manage these situations.
What do the new asthma guidelines say?
In the updated NAC Australian Asthma Handbook, released in September 2025, a key guideline change is that no adult or adolescent with asthma should be using salbutamol alone.
‘Every [adult or adolescent] with confirmed asthma now needs to be on an inhaled corticosteroid (ICS),’ A/Prof Rigby said.
The National Asthma Council recently released data that found there were 478 asthma-related deaths in 2024, equating to more than one per day.
There was a surprising increase in asthma deaths in the youngest patient cohort, those aged 0 to 35.
‘This is largely due to poorly controlled asthma, including people over-relying on SABA, not using preventers, or not using anti-inflammatory reliever therapy,’ Ms Rigby said. ‘Those with more severe symptoms should be on maintenance-and-reliever therapy, or MART.’
But that doesn't mean pharmacists should deny patients salbutamol, particularly during events such as storms that can trigger exacerbations.
‘Absolutely supply it if a patient has symptoms – it’s potentially life-saving during an acute episode – but we should be alluding to the fact that it’s risky to use salbutamol alone in asthma,’ she said. ‘‘Use it as an opportunity to explain that the guidelines have changed and that we now have better treatment, but also assess them to determine if they need to see a GP straightaway or go to ED.’
For example, if a patient can’t finish a sentence without taking a breath, they need immediate treatment.
Pharmacists should also remind patients that they should have an asthma action plan, which many adults don’t have. ‘Most people can manage with salbutamol in an acute situation – but they can also use budesonide-formoterol.’
It’s also important to point out the benefits of preventative and anti-inflammatory therapy, including improved asthma control and long-term health outcomes.
‘ICS–formoterol reduces the risk of severe episodes, it's more convenient because you only carry one inhaler and even has environmental benefits,’ A/Prof Rigby said. ‘There are about 15 million salbutamol inhalers used annually, which is a significant carbon footprint.’
What can pharmacists do?
A lot has been learned since the 2016 thunderstorm asthma event, A/Prof Rigby said.
‘The Victoria Department of Health has been very proactive with the pollen-alert apps that give daily high-pollen warnings,’ she said.
There are also similar systems in other states; these apps provide a daily alert using a traffic-light system across mapped regions.
‘For example [on Thursday], the Mildura area was “red” – very high pollen count,’ A/Prof Rigby said.
‘I encourage all pharmacists to sign up, but also to recommend them to patients with asthma and/or allergic rhinitis. When your area is on medium or high alert, pharmacists should be having conversations with patients about being prepared.’
This includes always having a reliever on hand – either salbutamol, or preferably, the anti-inflammatory reliever budesonide-formoterol.
‘During thunderstorm asthma – the “perfect storm” of high pollen plus thunderstorms – people should also avoid being outside, close windows, use air-conditioning, and in cars set air recirculation mode,’ she said.
And when patients present to the pharmacy for treatment for allergic rhinitis, pharmacists should ask: Do you have asthma?
‘Around 80% of people with asthma also have allergic rhinitis, and 40–60% of people with allergic rhinitis also have asthma,’ A/Prof Rigby said. ‘We need to think about “one airway, one disease.” If you get the nose under control, you get better asthma control – and vice versa.’
What’s the approach when it’s not asthma?
During the 2016 thunderstorm asthma event, many people who presented to pharmacies or EDs didn’t have diagnosed asthma, A/Prof Rigby said.
‘Many had hay fever or allergic rhinitis,’ she said. ‘So when people request hay fever treatments, pharmacists should ask about symptoms – such as shortness of breath, cough or chest tightness – which could indicate asthma.’
When these incidents occur, pharmacists should ask whether patients had childhood asthma, hay fever or other respiratory issues. They can also provide Asthma first aid.
‘You can supply a salbutamol puffer – ideally with a spacer – because when people are short of breath they’re less able to coordinate inhalation, and most people don’t use puffers correctly anyway,’ she said.
Pharmacists should use the 4x4x4 method: 4 puffs, one at a time, via a spacer; wait 4 minutes; repeat as needed.
‘If the patient is still short of breath, seek medical advice,’ A/Prof Rigby added. ‘And document everything.’
Pharmacists should also follow-up via phone, text or the next visit.
How should COPD be managed in a storm?
While asthma is reversible with good control, chronic obstructive pulmonary disease (COPD) involves persistent airway inflammation and irreversible obstruction.
Salbutamol may be used to relieve symptoms in patients with COPD, but it does not provide the same level of relief as it does in asthma, A/Prof Rigby said.
‘The perceived benefit of SABA for patients with COPD is often due to the person stopping and resting, or the anxiety relief of “doing something” – rather than actual bronchodilation,’ she said.
But patients with COPD are less likely to have their symptoms triggered by storms.
‘They may be short of breath at rest and have reduced exercise tolerance, so they must take preventative therapy regularly,’ A/Prof Rigby said.
This includes regular use of a long-acting muscarinic antagonist and long-acting beta2-agonist.
‘Only some patients need triple therapy,’ she added.
[post_title] => Severe spring storms show the risks of SABA overuse
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[post_content] => Allergic rhinitis (AR) remains a common but often underrecognised condition in Australian primary care1. Here’s what global experts shared at the 2025 FIP World Congress about how it should be managed.
With a prevalence of 23.9% in Australia,2 AR – commonly known as hay fever – significantly impacts patients’ quality of life, productivity, and often coexists with conditions such as asthma.3
The condition is caused by the nose and/or eyes coming into contact with allergens in the environment – such as pollens, dust mites, moulds and animal dander.2 When left untreated, AR can lead to complications including sleep disturbance, daytime tiredness, headaches, poor concentration, and recurrent ear or sinus infections.4
The role of pharmacists in AR management
Australian pharmacists play an increasingly vital role in the management of AR, supporting diagnostic differentiation, therapy optimisation and patient education in community settings.
Pharmacists can provide key interventions – including accurate symptom assessment, medicines recommendations and ongoing support for self-management.
Global updates: FIP 2025
At the 2025 FIP World Congress in Copenhagen, experts shared the latest evidence on AR management, highlighting innovations that can transform patient care. A key topic was the concept of antihistamines with 0% brain interference, such as fexofenadine. This antihistamine provides effective symptom relief without sedation, ensuring patients maintain cognitive performance and safety – critical for those operating machinery or driving.5
FIP President Paul Sinclair AM MPS, emphasised that pharmacists are uniquely positioned to lead AR management.
‘We know that people affected by AR can have their quality of life impacted quite dramatically, so it is important to intervene and recommend appropriate medication, which will relieve the symptoms and minimise the impact on somebody’s quality of life, so they can maintain all the things they need to do on a daily basis,’ he said
https://youtu.be/4no1XLK9TVs?si=dP-oEXSWEu_ohiJC
Watch on demand: 3rd Global Allergy Connect Meeting
Pharmacists in Australia can enhance their expertise in AR by accessing on-demand resources and lectures from the 2025 FIP World Congress. After registering with their professional details, pharmacists can view content from the 3rd Global Allergy Connect Meeting, where experts from the United Kingdom, Spain, and France discuss AR, antihistamines with 0% brain interference (such as fexofenadine), clinical evidence, and strategies for managing AR in community pharmacy settings.
For access:
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[post_content] => From mid-2027, the availability of dozens and dozens of complementary medicines containing vitamin B6 will change.
Yesterday (25 November 2025), the Therapeutic Goods Administration (TGA) released the final decision on the scheduling of vitamin B6 containing medicines in response to safety concerns following consideration of the advice of the Advisory Committee on Medicines Scheduling in November 2024 and public consultation.
What's changing?
The TGA Delegate’s final decision will see scheduling changes for products containing vitamin B6, dependent on the product’s vitamin B6 dose. This means oral preparations containing:
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[post_content] => These case examples show that errors arise from system pressures, not individual failings. Pharmacists can act on these insights to strengthen governance.
When pharmacists call Pharmaceutical Defence Limited (PDL), they’re often navigating some of the most stressful moments of their professional lives.
Behind the scenes, PDL’s professional officers, including pharmacist Claire Bekema – who is also a professional practice pharmacist at PSA – talk pharmacists through clinical decisions, regulatory notifications and incident management.
Here, Ms Bekema outlines the top incidents reported to PDL, alongside practical strategies to reduce risk and respond safely when something goes wrong.
Wrong-patient supply leads to hospital admission
Wrong-patient incidents remain one of the most common and serious error types, often occurring when workflow pressures and assumptions collide.
‘That might be when you call out a script for “[one surname], and somebody just turns up and says, “Yep, that’s me,” and they take it out the door,’ Ms Bekema told participants of PSA’s Voices of Pharmacy – Passion, Purpose, and Possibility webinar last week (26 November).
In one case, which occurred after 60 Day Dispensing was implemented, a patient received two boxes of multiple medicines that were not theirs.
‘It was high-dose antihypertensives, and the patient had low health literacy, so they didn’t know what they were expecting to receive from the doctor,’ she said.
‘They picked up this other person’s medicines and they took one from each box. So they took really high doses of antihypertensives all at once.’
Once errors such as this are discovered, Ms Bekema is clear about what the next steps should be.
‘In this particular scenario, I said, “Let’s talk about the incident and how it occurred later, but the first thing is: try and track down this patient and make sure they’re receiving medical attention”,’ she said.
‘They ended up being transferred to hospital by ambulance because their blood pressure was [extremely low]. Wrong-patient errors can have pretty dire consequences.’
For more information, refer to previous AP coverage on:
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[post_content] => The Therapeutic Goods Administration (TGA) has today (Monday 1 December) made updates to product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists for two separate safety issues.
AP examines what pharmacists need to know.
ALERT 1: Potential risk of suicidal thoughts
The TGA has aligned product warnings for all GLP-1 RA medicines to ensure consistent information regarding the potential risk of suicidal thoughts or behaviours.
There have been growing questions about whether there’s a link between GLP-1 RAs and suicidal ideation. As of 23 September 2025, the TGA’s Database of Adverse Event Notifications (DAEN) contains the following:
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[post_content] => Australia’s east coast was belted with heavy storms last week. Spring and summer storms can trigger thunderstorm asthma – with bursts of pollen often causing sudden, severe asthma attacks, particularly in patients with asthma or allergic rhinitis.
‘There was the big event in Victoria in November 2016 when 10 people died,’ said Clinical Associate Professor Debbie Rigby FPS, pharmacist and Clinical Executive Lead, National Asthma Council Australia (NAC).
‘But there are other peaks that don’t get as much media coverage – for example, there was terrible weather on Melbourne Cup Day this year, and data showed there were over 100 emergency department (ED) admissions and ambulance callouts that day.’
When asthma symptoms spike, so do SABA (short-acting beta2-agonist) requests. With new guidelines that discourage overreliance on SABA, asthma expert A/Prof Rigby explains how pharmacists should manage these situations.
What do the new asthma guidelines say?
In the updated NAC Australian Asthma Handbook, released in September 2025, a key guideline change is that no adult or adolescent with asthma should be using salbutamol alone.
‘Every [adult or adolescent] with confirmed asthma now needs to be on an inhaled corticosteroid (ICS),’ A/Prof Rigby said.
The National Asthma Council recently released data that found there were 478 asthma-related deaths in 2024, equating to more than one per day.
There was a surprising increase in asthma deaths in the youngest patient cohort, those aged 0 to 35.
‘This is largely due to poorly controlled asthma, including people over-relying on SABA, not using preventers, or not using anti-inflammatory reliever therapy,’ Ms Rigby said. ‘Those with more severe symptoms should be on maintenance-and-reliever therapy, or MART.’
But that doesn't mean pharmacists should deny patients salbutamol, particularly during events such as storms that can trigger exacerbations.
‘Absolutely supply it if a patient has symptoms – it’s potentially life-saving during an acute episode – but we should be alluding to the fact that it’s risky to use salbutamol alone in asthma,’ she said. ‘‘Use it as an opportunity to explain that the guidelines have changed and that we now have better treatment, but also assess them to determine if they need to see a GP straightaway or go to ED.’
For example, if a patient can’t finish a sentence without taking a breath, they need immediate treatment.
Pharmacists should also remind patients that they should have an asthma action plan, which many adults don’t have. ‘Most people can manage with salbutamol in an acute situation – but they can also use budesonide-formoterol.’
It’s also important to point out the benefits of preventative and anti-inflammatory therapy, including improved asthma control and long-term health outcomes.
‘ICS–formoterol reduces the risk of severe episodes, it's more convenient because you only carry one inhaler and even has environmental benefits,’ A/Prof Rigby said. ‘There are about 15 million salbutamol inhalers used annually, which is a significant carbon footprint.’
What can pharmacists do?
A lot has been learned since the 2016 thunderstorm asthma event, A/Prof Rigby said.
‘The Victoria Department of Health has been very proactive with the pollen-alert apps that give daily high-pollen warnings,’ she said.
There are also similar systems in other states; these apps provide a daily alert using a traffic-light system across mapped regions.
‘For example [on Thursday], the Mildura area was “red” – very high pollen count,’ A/Prof Rigby said.
‘I encourage all pharmacists to sign up, but also to recommend them to patients with asthma and/or allergic rhinitis. When your area is on medium or high alert, pharmacists should be having conversations with patients about being prepared.’
This includes always having a reliever on hand – either salbutamol, or preferably, the anti-inflammatory reliever budesonide-formoterol.
‘During thunderstorm asthma – the “perfect storm” of high pollen plus thunderstorms – people should also avoid being outside, close windows, use air-conditioning, and in cars set air recirculation mode,’ she said.
And when patients present to the pharmacy for treatment for allergic rhinitis, pharmacists should ask: Do you have asthma?
‘Around 80% of people with asthma also have allergic rhinitis, and 40–60% of people with allergic rhinitis also have asthma,’ A/Prof Rigby said. ‘We need to think about “one airway, one disease.” If you get the nose under control, you get better asthma control – and vice versa.’
What’s the approach when it’s not asthma?
During the 2016 thunderstorm asthma event, many people who presented to pharmacies or EDs didn’t have diagnosed asthma, A/Prof Rigby said.
‘Many had hay fever or allergic rhinitis,’ she said. ‘So when people request hay fever treatments, pharmacists should ask about symptoms – such as shortness of breath, cough or chest tightness – which could indicate asthma.’
When these incidents occur, pharmacists should ask whether patients had childhood asthma, hay fever or other respiratory issues. They can also provide Asthma first aid.
‘You can supply a salbutamol puffer – ideally with a spacer – because when people are short of breath they’re less able to coordinate inhalation, and most people don’t use puffers correctly anyway,’ she said.
Pharmacists should use the 4x4x4 method: 4 puffs, one at a time, via a spacer; wait 4 minutes; repeat as needed.
‘If the patient is still short of breath, seek medical advice,’ A/Prof Rigby added. ‘And document everything.’
Pharmacists should also follow-up via phone, text or the next visit.
How should COPD be managed in a storm?
While asthma is reversible with good control, chronic obstructive pulmonary disease (COPD) involves persistent airway inflammation and irreversible obstruction.
Salbutamol may be used to relieve symptoms in patients with COPD, but it does not provide the same level of relief as it does in asthma, A/Prof Rigby said.
‘The perceived benefit of SABA for patients with COPD is often due to the person stopping and resting, or the anxiety relief of “doing something” – rather than actual bronchodilation,’ she said.
But patients with COPD are less likely to have their symptoms triggered by storms.
‘They may be short of breath at rest and have reduced exercise tolerance, so they must take preventative therapy regularly,’ A/Prof Rigby said.
This includes regular use of a long-acting muscarinic antagonist and long-acting beta2-agonist.
‘Only some patients need triple therapy,’ she added.
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[post_content] => Allergic rhinitis (AR) remains a common but often underrecognised condition in Australian primary care1. Here’s what global experts shared at the 2025 FIP World Congress about how it should be managed.
With a prevalence of 23.9% in Australia,2 AR – commonly known as hay fever – significantly impacts patients’ quality of life, productivity, and often coexists with conditions such as asthma.3
The condition is caused by the nose and/or eyes coming into contact with allergens in the environment – such as pollens, dust mites, moulds and animal dander.2 When left untreated, AR can lead to complications including sleep disturbance, daytime tiredness, headaches, poor concentration, and recurrent ear or sinus infections.4
The role of pharmacists in AR management
Australian pharmacists play an increasingly vital role in the management of AR, supporting diagnostic differentiation, therapy optimisation and patient education in community settings.
Pharmacists can provide key interventions – including accurate symptom assessment, medicines recommendations and ongoing support for self-management.
Global updates: FIP 2025
At the 2025 FIP World Congress in Copenhagen, experts shared the latest evidence on AR management, highlighting innovations that can transform patient care. A key topic was the concept of antihistamines with 0% brain interference, such as fexofenadine. This antihistamine provides effective symptom relief without sedation, ensuring patients maintain cognitive performance and safety – critical for those operating machinery or driving.5
FIP President Paul Sinclair AM MPS, emphasised that pharmacists are uniquely positioned to lead AR management.
‘We know that people affected by AR can have their quality of life impacted quite dramatically, so it is important to intervene and recommend appropriate medication, which will relieve the symptoms and minimise the impact on somebody’s quality of life, so they can maintain all the things they need to do on a daily basis,’ he said
https://youtu.be/4no1XLK9TVs?si=dP-oEXSWEu_ohiJC
Watch on demand: 3rd Global Allergy Connect Meeting
Pharmacists in Australia can enhance their expertise in AR by accessing on-demand resources and lectures from the 2025 FIP World Congress. After registering with their professional details, pharmacists can view content from the 3rd Global Allergy Connect Meeting, where experts from the United Kingdom, Spain, and France discuss AR, antihistamines with 0% brain interference (such as fexofenadine), clinical evidence, and strategies for managing AR in community pharmacy settings.
For access:
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[post_content] => From mid-2027, the availability of dozens and dozens of complementary medicines containing vitamin B6 will change.
Yesterday (25 November 2025), the Therapeutic Goods Administration (TGA) released the final decision on the scheduling of vitamin B6 containing medicines in response to safety concerns following consideration of the advice of the Advisory Committee on Medicines Scheduling in November 2024 and public consultation.
What's changing?
The TGA Delegate’s final decision will see scheduling changes for products containing vitamin B6, dependent on the product’s vitamin B6 dose. This means oral preparations containing:
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[post_content] => These case examples show that errors arise from system pressures, not individual failings. Pharmacists can act on these insights to strengthen governance.
When pharmacists call Pharmaceutical Defence Limited (PDL), they’re often navigating some of the most stressful moments of their professional lives.
Behind the scenes, PDL’s professional officers, including pharmacist Claire Bekema – who is also a professional practice pharmacist at PSA – talk pharmacists through clinical decisions, regulatory notifications and incident management.
Here, Ms Bekema outlines the top incidents reported to PDL, alongside practical strategies to reduce risk and respond safely when something goes wrong.
Wrong-patient supply leads to hospital admission
Wrong-patient incidents remain one of the most common and serious error types, often occurring when workflow pressures and assumptions collide.
‘That might be when you call out a script for “[one surname], and somebody just turns up and says, “Yep, that’s me,” and they take it out the door,’ Ms Bekema told participants of PSA’s Voices of Pharmacy – Passion, Purpose, and Possibility webinar last week (26 November).
In one case, which occurred after 60 Day Dispensing was implemented, a patient received two boxes of multiple medicines that were not theirs.
‘It was high-dose antihypertensives, and the patient had low health literacy, so they didn’t know what they were expecting to receive from the doctor,’ she said.
‘They picked up this other person’s medicines and they took one from each box. So they took really high doses of antihypertensives all at once.’
Once errors such as this are discovered, Ms Bekema is clear about what the next steps should be.
‘In this particular scenario, I said, “Let’s talk about the incident and how it occurred later, but the first thing is: try and track down this patient and make sure they’re receiving medical attention”,’ she said.
‘They ended up being transferred to hospital by ambulance because their blood pressure was [extremely low]. Wrong-patient errors can have pretty dire consequences.’
For more information, refer to previous AP coverage on:
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[post_content] => The Therapeutic Goods Administration (TGA) has today (Monday 1 December) made updates to product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists for two separate safety issues.
AP examines what pharmacists need to know.
ALERT 1: Potential risk of suicidal thoughts
The TGA has aligned product warnings for all GLP-1 RA medicines to ensure consistent information regarding the potential risk of suicidal thoughts or behaviours.
There have been growing questions about whether there’s a link between GLP-1 RAs and suicidal ideation. As of 23 September 2025, the TGA’s Database of Adverse Event Notifications (DAEN) contains the following:
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[post_content] => Australia’s east coast was belted with heavy storms last week. Spring and summer storms can trigger thunderstorm asthma – with bursts of pollen often causing sudden, severe asthma attacks, particularly in patients with asthma or allergic rhinitis.
‘There was the big event in Victoria in November 2016 when 10 people died,’ said Clinical Associate Professor Debbie Rigby FPS, pharmacist and Clinical Executive Lead, National Asthma Council Australia (NAC).
‘But there are other peaks that don’t get as much media coverage – for example, there was terrible weather on Melbourne Cup Day this year, and data showed there were over 100 emergency department (ED) admissions and ambulance callouts that day.’
When asthma symptoms spike, so do SABA (short-acting beta2-agonist) requests. With new guidelines that discourage overreliance on SABA, asthma expert A/Prof Rigby explains how pharmacists should manage these situations.
What do the new asthma guidelines say?
In the updated NAC Australian Asthma Handbook, released in September 2025, a key guideline change is that no adult or adolescent with asthma should be using salbutamol alone.
‘Every [adult or adolescent] with confirmed asthma now needs to be on an inhaled corticosteroid (ICS),’ A/Prof Rigby said.
The National Asthma Council recently released data that found there were 478 asthma-related deaths in 2024, equating to more than one per day.
There was a surprising increase in asthma deaths in the youngest patient cohort, those aged 0 to 35.
‘This is largely due to poorly controlled asthma, including people over-relying on SABA, not using preventers, or not using anti-inflammatory reliever therapy,’ Ms Rigby said. ‘Those with more severe symptoms should be on maintenance-and-reliever therapy, or MART.’
But that doesn't mean pharmacists should deny patients salbutamol, particularly during events such as storms that can trigger exacerbations.
‘Absolutely supply it if a patient has symptoms – it’s potentially life-saving during an acute episode – but we should be alluding to the fact that it’s risky to use salbutamol alone in asthma,’ she said. ‘‘Use it as an opportunity to explain that the guidelines have changed and that we now have better treatment, but also assess them to determine if they need to see a GP straightaway or go to ED.’
For example, if a patient can’t finish a sentence without taking a breath, they need immediate treatment.
Pharmacists should also remind patients that they should have an asthma action plan, which many adults don’t have. ‘Most people can manage with salbutamol in an acute situation – but they can also use budesonide-formoterol.’
It’s also important to point out the benefits of preventative and anti-inflammatory therapy, including improved asthma control and long-term health outcomes.
‘ICS–formoterol reduces the risk of severe episodes, it's more convenient because you only carry one inhaler and even has environmental benefits,’ A/Prof Rigby said. ‘There are about 15 million salbutamol inhalers used annually, which is a significant carbon footprint.’
What can pharmacists do?
A lot has been learned since the 2016 thunderstorm asthma event, A/Prof Rigby said.
‘The Victoria Department of Health has been very proactive with the pollen-alert apps that give daily high-pollen warnings,’ she said.
There are also similar systems in other states; these apps provide a daily alert using a traffic-light system across mapped regions.
‘For example [on Thursday], the Mildura area was “red” – very high pollen count,’ A/Prof Rigby said.
‘I encourage all pharmacists to sign up, but also to recommend them to patients with asthma and/or allergic rhinitis. When your area is on medium or high alert, pharmacists should be having conversations with patients about being prepared.’
This includes always having a reliever on hand – either salbutamol, or preferably, the anti-inflammatory reliever budesonide-formoterol.
‘During thunderstorm asthma – the “perfect storm” of high pollen plus thunderstorms – people should also avoid being outside, close windows, use air-conditioning, and in cars set air recirculation mode,’ she said.
And when patients present to the pharmacy for treatment for allergic rhinitis, pharmacists should ask: Do you have asthma?
‘Around 80% of people with asthma also have allergic rhinitis, and 40–60% of people with allergic rhinitis also have asthma,’ A/Prof Rigby said. ‘We need to think about “one airway, one disease.” If you get the nose under control, you get better asthma control – and vice versa.’
What’s the approach when it’s not asthma?
During the 2016 thunderstorm asthma event, many people who presented to pharmacies or EDs didn’t have diagnosed asthma, A/Prof Rigby said.
‘Many had hay fever or allergic rhinitis,’ she said. ‘So when people request hay fever treatments, pharmacists should ask about symptoms – such as shortness of breath, cough or chest tightness – which could indicate asthma.’
When these incidents occur, pharmacists should ask whether patients had childhood asthma, hay fever or other respiratory issues. They can also provide Asthma first aid.
‘You can supply a salbutamol puffer – ideally with a spacer – because when people are short of breath they’re less able to coordinate inhalation, and most people don’t use puffers correctly anyway,’ she said.
Pharmacists should use the 4x4x4 method: 4 puffs, one at a time, via a spacer; wait 4 minutes; repeat as needed.
‘If the patient is still short of breath, seek medical advice,’ A/Prof Rigby added. ‘And document everything.’
Pharmacists should also follow-up via phone, text or the next visit.
How should COPD be managed in a storm?
While asthma is reversible with good control, chronic obstructive pulmonary disease (COPD) involves persistent airway inflammation and irreversible obstruction.
Salbutamol may be used to relieve symptoms in patients with COPD, but it does not provide the same level of relief as it does in asthma, A/Prof Rigby said.
‘The perceived benefit of SABA for patients with COPD is often due to the person stopping and resting, or the anxiety relief of “doing something” – rather than actual bronchodilation,’ she said.
But patients with COPD are less likely to have their symptoms triggered by storms.
‘They may be short of breath at rest and have reduced exercise tolerance, so they must take preventative therapy regularly,’ A/Prof Rigby said.
This includes regular use of a long-acting muscarinic antagonist and long-acting beta2-agonist.
‘Only some patients need triple therapy,’ she added.
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[post_content] => Allergic rhinitis (AR) remains a common but often underrecognised condition in Australian primary care1. Here’s what global experts shared at the 2025 FIP World Congress about how it should be managed.
With a prevalence of 23.9% in Australia,2 AR – commonly known as hay fever – significantly impacts patients’ quality of life, productivity, and often coexists with conditions such as asthma.3
The condition is caused by the nose and/or eyes coming into contact with allergens in the environment – such as pollens, dust mites, moulds and animal dander.2 When left untreated, AR can lead to complications including sleep disturbance, daytime tiredness, headaches, poor concentration, and recurrent ear or sinus infections.4
The role of pharmacists in AR management
Australian pharmacists play an increasingly vital role in the management of AR, supporting diagnostic differentiation, therapy optimisation and patient education in community settings.
Pharmacists can provide key interventions – including accurate symptom assessment, medicines recommendations and ongoing support for self-management.
Global updates: FIP 2025
At the 2025 FIP World Congress in Copenhagen, experts shared the latest evidence on AR management, highlighting innovations that can transform patient care. A key topic was the concept of antihistamines with 0% brain interference, such as fexofenadine. This antihistamine provides effective symptom relief without sedation, ensuring patients maintain cognitive performance and safety – critical for those operating machinery or driving.5
FIP President Paul Sinclair AM MPS, emphasised that pharmacists are uniquely positioned to lead AR management.
‘We know that people affected by AR can have their quality of life impacted quite dramatically, so it is important to intervene and recommend appropriate medication, which will relieve the symptoms and minimise the impact on somebody’s quality of life, so they can maintain all the things they need to do on a daily basis,’ he said
https://youtu.be/4no1XLK9TVs?si=dP-oEXSWEu_ohiJC
Watch on demand: 3rd Global Allergy Connect Meeting
Pharmacists in Australia can enhance their expertise in AR by accessing on-demand resources and lectures from the 2025 FIP World Congress. After registering with their professional details, pharmacists can view content from the 3rd Global Allergy Connect Meeting, where experts from the United Kingdom, Spain, and France discuss AR, antihistamines with 0% brain interference (such as fexofenadine), clinical evidence, and strategies for managing AR in community pharmacy settings.
For access:
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[post_content] => From mid-2027, the availability of dozens and dozens of complementary medicines containing vitamin B6 will change.
Yesterday (25 November 2025), the Therapeutic Goods Administration (TGA) released the final decision on the scheduling of vitamin B6 containing medicines in response to safety concerns following consideration of the advice of the Advisory Committee on Medicines Scheduling in November 2024 and public consultation.
What's changing?
The TGA Delegate’s final decision will see scheduling changes for products containing vitamin B6, dependent on the product’s vitamin B6 dose. This means oral preparations containing:
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