Allercy and Asthma Health
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The Official Publication of AAN - MA

Get Ready To Say Goodbye
to OTC Epinephrine Inhalers

by Thomas Kallstrom, MBA, RRT, FAARC

primatene mist

Despite the fact that there are many safe and effective asthma medications on the market today, some people with asthma continue to rely on over-the-counter (OTC) epinephrine inhalers like Primatene Mist when their asthma flares up. If you are one of them–or know someone who is–you should know that the days of picking up these inhalers at the local drug store are quickly coming to an end.

According to the Food and Drug Administration, OTC epinephrine inhalers can no longer be made or sold after December 31 of this year. The inhalers are being phased out because they contain propellants called chlorofluorocarbons, or “CFCs” for short. These propellants harm the environment, and the U.S. government has been slowly phasing out products containing them for years.

Asthma sufferers who use these inhalers probably think this is very bad news, but as a respiratory therapist, I can tell you that it is really a blessing in disguise. While OTC inhalers can help open up your lungs when sudden symptoms occur, they only provide about 30 minutes worth of relief. Since the relief is short-lived, people tend to use too much of the drug, and that can cause serious side effects. Difficulty sleeping, a fast heartbeat, headache, loss of appetite, nausea, nervousness, and tremors are all commonly reported.

Severe allergic reactions are rare, but can include rash, hives, itching, difficulty breathing, tightness in the chest, and swelling of the mouth, face, lips, or tongue.

Perhaps the worst thing about these inhalers, however, is the fact that they keep people from visiting their doctor, where they could get the kind of medications they need to control the underlying cause of asthma, which is airway inflammation. When airway inflammation is adequately controlled, most people have significantly fewer asthma flare-ups and many have none at all.

In many doctors’ offices, you’ll also receive information on asthma triggers and how to avoid them, an “asthma action plan” outlining what to do if symptoms do occur, and instruction on using your asthma medications correctly.

But where does all this leave the person who would still prefer to use OTC inhalers because they’re easy to get and cost a lot less than going to the doctor and getting a prescription? Will epinephrine inhaler manufacturers make a new OTC inhaler that doesn’t contain CFCs and thus can still be sold? The answer to that question is probably no, because newer propellants cost much more than CFCs and manufacturers most likely could not price the new OTC inhalers low enough to compete with prescription drugs that work much better.

So, the best advice is to make that initial doctor’s visit now, before the OTC inhalers go off the market. The Centers for Disease Control and Prevention says there are programs available to help with medication costs, and your health care professionals can help you find them. For example, some drug companies offer medication assistance programs for people who have a hard time paying for their prescriptions, and assistance may also be available from government agencies.

Thomas Kallstrom is a Registered Respiratory Therapist and serves as chief operating officer of the American Association for Respiratory Care.
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