Until about two weeks ago, Ventolin could still be found, with difficulty, in a handful of Israeli pharmacies. Today, it has almost entirely disappeared from the shelves, and the country’s health funds have stopped prescribing it.
The official announcement from pharmaceutical company GSK merely confirmed what many parents had already experienced firsthand: Ventolin, the inhaler used by generations of asthma patients in Israel, will not be returning.
For millions of people with asthma and other lung diseases, the inhaler has long represented far more than another medication. It meant immediate access to air. Ventolin is the most widely used inhaler in pediatric medicine. It does not treat the underlying cause of asthma, but for the overwhelming majority of patients it provides rapid and essential relief during an attack. Some patients have used it successfully and confidently for decades.
In recent months, however, their reality has changed dramatically. Many have found themselves rushing anxiously from pharmacy to pharmacy in a desperate search for the few remaining inhalers available for sale.
Israel is estimated to have about half a million asthma patients with varying degrees of disease severity. Asthma is the country’s most common chronic childhood disease, affecting about 10% of Israeli children. The upheaval in the market is not temporary. Following months of shortages and attempts to import supplies from abroad, Ventolin manufacturer GSK informed the Health Ministry that it was ending sales of the inhaler in Israel.
The remaining question is what will happen to the many patients who rely on it, including large numbers of children, and who lack access to pulmonary specialists capable of prescribing an effective and readily available alternative for a condition that can become urgent and sometimes life-threatening.
The race to find an inhaler
Ventolin, whose active ingredient is salbutamol, was developed in 1968 by a British company and was considered one of the major breakthroughs in pulmonary medicine. It acted rapidly on the airways while significantly reducing cardiovascular side effects compared with earlier treatments.
Its unprecedented ability to dilate the bronchial tubes within seconds, combined with a far better safety profile than its predecessors, allowed Ventolin to dominate the market virtually unchallenged for decades.
In recent years, however, its distribution in Israel has repeatedly been disrupted. The shortage began becoming noticeable in 2023 and recently reached its peak, leaving pharmacy shelves empty and forcing medical teams to improvise. Instead of Ventolin, many doctors prescribed alternatives, including nebulizer treatments and less commonly used inhalers containing the same active ingredient.
The Health Ministry intervened in individual cases and authorized imports of substitute products. Now, however, the company has officially announced that it is permanently discontinuing sales of the familiar inhaler.
In recent weeks, many parents and children who rely on the inhaler have faced severe anxiety over the loss of an essential treatment and the absence of a suitable alternative during a potentially life-threatening asthma attack.
“We have a small supply at home that I built up once I understood that I could no longer count on finding it at the pharmacy, but I am extremely anxious about this forced change in his treatment,” said the mother of a 9-year-old boy who has used Ventolin since he was 3. “In recent weeks, I begged the doctor for prescriptions and went to every pharmacy in the city. I managed to find two final inhalers, but that supply will run out very quickly.”
She said Ventolin was the only medication that provided her son with immediate relief during an asthma attack. “It works within seconds of his using the inhaler,” she said. “During the fall and winter virus season, he uses Ventolin to prevent attacks together with another inhaler containing steroids, three times a day. “We tried one of the substitutes, but the taste was a problem for him.
“It is summer now, so his attacks are less frequent. But I have no idea what we will do in a few weeks, when the weather cools and respiratory viruses return. During that season, it is an almost daily treatment that is essential for him.”
‘Like giving acetaminophen for an infection’
While patients remain deeply concerned, pulmonary specialists see the current crisis as an opportunity to correct what they describe as outdated treatment practices.
'It is an almost daily treatment that is essential for him'
(Photo: Shutterstock)
Dr. Inbal Shafran, a senior physician in the pulmonary division at Rabin (Beilinson) Medical Center and a member of the Israel Society of Pulmonology’s executive committee, said prolonged reliance on rapid-relief inhalers alone is misguided and potentially dangerous.“Ventolin relieves the attack, but it can mask the fact that the underlying problem is not being treated,” she said. “It is like giving acetaminophen for an infection.”
According to Shafran, excessive reliance on the inhaler without treating the chronic underlying inflammation in the bronchial tubes can worsen asthma over time. It may even lead to a severe condition involving persistent airway obstruction that no longer responds adequately to treatment.
Updated international medical guidelines increasingly encourage a move toward combined treatment, often known as maintenance and reliever therapy, or MART. The approach involves regular use of anti-inflammatory inhaled steroids together with a bronchodilator.
“The current recommendation is to move to combination inhalers that provide both prevention and relief,” Shafran said. Another advantage is the duration of their effect. “While Ventolin works for four hours, the other inhalers can provide coverage for up to 12 hours,” she said.
No appointments available with pulmonary specialists
Replacing the traditional treatment and urgently adapting prescriptions to the products available on the market has exposed another serious weakness in Israel’s health care system. There are not enough available appointments with pulmonary specialists to reassess treatment quickly for such a large number of patients.
In most cases, patients must wait months for an appointment. Family doctors and community pediatricians, to whom most anxious patients initially turn, are not always sufficiently familiar with the range of newer alternatives or the correct ways to use them. “Our pediatrician was at a loss and gave us an alternative treatment that, in my opinion, is unsuitable for him because of his age and the complexity of using it,” the boy’s mother said.
To bridge that gap and prevent patients from being left without appropriate medical care, pulmonary specialists and the Israel Society of Pulmonology have launched intensive educational initiatives for community medical teams.
“We are trying to distribute guidelines and key points in doctors’ WhatsApp and Facebook groups, explaining which inhalers patients should be switched to and what should be prescribed,” Shafran said. The aim is to make the information available quickly so community doctors can guide patients toward updated treatment without forcing them to wait months for a specialist.
But Shafran acknowledged the logistical challenge. “I know not every patient can immediately see a family doctor or pulmonary specialist and receive a new prescription,” she said. “The transition will take time.”
What are the alternatives?
Israel Society of Pulmonology recommends that patients not stop treatment on their own. They should consult their family doctor or pulmonary specialist to select an alternative and develop an updated treatment plan.
Following medical consultation, several alternatives are available in Israel:
Direct generic alternatives (for rapid relief only): Patients who require the original active ingredient may use therapeutically equivalent salbutamol inhalers such as Salamol or Salbutrim.
Advanced combination inhalers (for both prevention and relief): The most up-to-date recommended treatment approach is based on inhalers such as Foster, Symbicort or DuoResp. Foster, for example, may be taken at a fixed dose in the morning and evening as maintenance anti-inflammatory therapy, with additional doses used during an episode of shortness of breath as a reliever inhaler, according to a physician’s instructions.
GSK said in response: “Following an assessment of existing treatment alternatives, including their availability and accessibility to patients, a decision was made to discontinue marketing the Ventolin MDI inhaler containing salbutamol.
“Alternative treatments are currently available, and most patients who use an MDI inhaler already use a generic version. Patients who currently use a Ventolin MDI inhaler should consult their treating physician to select the most appropriate alternative.”