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Epinephrine Inhalers Will Be Phased Out by Dec. 31, 2011

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The Official Publication of AAN - MA

Epinephrine Inhalers Will Be Phased out by Dec. 31, 2011

by Debbie Bunch

Although over-the-counter epinephrine inhalers have been on the market for decades and can relieve acute asthma symptoms, these medications are known to have serious side effects when used in higher doses. In addition, they are not recommended by the National Heart, Lung, and Blood Institute’s Expert Panel Report 3 asthma guidelines. As a result, last year the U.S. Food and Drug Administration (FDA) denied the request for “essential-use” designation for these chlorofluorocarbon (CFC)-propelled devices. The ruling means that epinephrine inhalers will become unavailable in the United States after Dec. 31, 2011.

According to several lung experts, the coming change provides the perfect opportunity for respiratory patients to talk with their doctor or respiratory therapist about epinephrine’s downsides and learn why it is a good thing these inhalers are being removed from the market. Pediatric respiratory therapist Brian Walsh, RRT-NPS, RPFT, FAARC, from Children’s Hospital Boston in Boston, MA, notes that while the drug is inexpensive and can afford quick relief of symptoms, it is not the safest option for people with asthma because it only offers brief relief. Larger doses are required for continuing relief, and larger doses put patients at risk for serious problems. Epinephrine is not a primary rescue medication, he says, and taking it off the market can protect people from serious cardiac side effects such as arrhythmia, hypertension, and possible heart attack.

Karen Gregory, MS, APRN-BC, CNS, RRT, AE-C, pulmonary disease management specialist at the Oklahoma Allergy and Asthma Clinic in Oklahoma City, OK, says, “Epinephrine… can also foster a false sense of security among asthma patients because the quick fix they get from every puff convinces them the medication is all they really need to bring their asthma under control. OTC epinephrine inhalers will possibly delay patients with asthma from seeking appropriate medical care, increasing the risk of fatal asthma.”

American Association for Respiratory Care (AARC) President Timothy Myers, BS, RRT-NPS, director of pediatric respiratory care at University Hospital’s Rainbow Babies & Children’s Hospital and Case Western Reserve University School of Medicine in Cleveland, OH, says the phase out will foster better communication between patients and their asthma care providers and even save lives and drug costs. “Few people believe the pharmaceutical companies will reformulate these drugs in CFC-free inhalers; and even if they did, costs would rise substantially, erasing the savings people see now.”

Myers notes that one possible danger is that “people who cannot afford their medications may attempt to go without their reliever medications for longer periods of time, leading to a loss of asthma control, increase in symptoms, and more exacerbations.” Relatively inexpensive albuterol inhalers containing CFCs were pulled from the market last December, requiring patients to purchase much more expensive hydrofluoroalkane (HFA) alternatives. While the overall objective is a good one (to reduce ozone-depleting CFCs in the atmosphere), the reality is patients may be relying more heavily on OTC medications right now.

The problem is expected to impact families with lower incomes and the uninsured more than others. Patients may be at increased risk for unscheduled emergency room visits and hospital admissions because they are not financially able to refill medications. Asthma educators are making a difference for these patients. “Asthma educators and other health care providers can provide information to patients about prescription assistance programs and pharmaceutical companies offering coupons for financial support,” says Gregory.

Brian Walsh says, “When money gets tight for whatever reason, many patients will refill their rescue medication but not their controller medication.” This could be dangerous. Walsh believes it is a partnership between the asthma care provider and the patient that can do the most good.  Patients need alternatives, and that means taking time to call the insurance provider, getting prescription justifications, and/or helping with applications for the multiple pharmaceutical assistance programs that are available.

The coming phase-out means that asthma patients should go to see a physician who works with asthma patients. An asthma action plan can be formulated and extensive asthma education given to help patients achieve ultimate asthma control.

With the phase-out, asthma triggers and environmental controls should be taken more seriously, since managing the home environment can reduce the need for rescue inhalers in the first place.

So talk with your doctor or respiratory therapist now about controlling your asthma. After Dec. 31, 2011, the over-the-counter epinephrine option will no longer exist.

Debbie Bunch is a Dallas-based free-lance writer who has written respiratory care-related articles for the American Association for Respiratory Care for 30 years. This article was recently published in the AARC publication, AARC Times.

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