Before You Use an Over-the-Counter Asthma Inhaler

Uses and concerns about the nonprescription asthmanefrin inhaler

asthmatic fanatic
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With the high cost of prescription inhalers, you may wonder whether over-the-counter asthma inhaler medications are available in the United States. Asthmanefrin (racepinephrine) is a currently available nonprescription OTC inhaler medication. These types of asthma medications are designed for the temporary relief of asthma symptoms such as shortness of breath, chest tightness, and wheezing. Before you decide to use an OTC asthma inhaler, see why it may or may not be a good choice.

Should You Use an OTC Asthma Inhaler?

How sure are you that your symptoms are asthma? Many patients report using over-the-counter products before getting a diagnosis, despite OTC asthma inhalers not being labeled for this purpose. Classic asthma leads to the following symptoms:

However, these symptoms can be part of other serious diseases as well. An OTC asthma inhaler may provide symptom relief and mask some more serious conditions such as heart disease or COPD. If you are not sure about your symptoms, make sure you get checked out by a healthcare professional.

Additionally, OTC asthma inhalers state in their packaging they are only to be used for temporary relief and the most recently approved OTC asthma med clearly states that you should be diagnosed by a physician with asthma before using.

Asthma is not a minor condition. You may be at risk for a fatal asthma attack.

 If you have poorly controlled symptoms, an OTC asthma inhaler is probably not for you.

Side Effects of OTC Asthma Inhalers

Just like prescription medications, OTC medications also carry a risk of side effects. Common side effects of OTC asthma inhalers include:

  • Appetite changes
  • Dizziness
  • Headache
  • Hyperactivity
  • Nausea
  • Nervousness
  • Shakiness
  • Sinus pain
  • Sore throat
  • Tremor
  • Trouble sleeping
  • Vomiting

Safety Concerns for OTC Inhalers

Finally, is an OTC asthma inhaler safe? Some healthcare providers do not feel OTC asthma inhalers are safe. They point out that medications for other serious conditions such as diabetes or heart disease are not sold over-the-counter.

The FDA has issued a warning specifically for Asthmanefrin and its EZ Breathe Atomizer. They warned patients that they had received complaints about chest pain, high blood pressure, nausea and vomiting, and spitting up pink or red sputum. Also, a study found that Asthmanefrin provided less bronchoprotection than albuterol and may be less effective in treating acute bronchospasm.

Older research seemed to indicate that over-the-counter inhalers are safe when used correctly by people with mild, intermittent asthma. The problem was that 1 in 5 patients wasn't using them correctly. An article in Chest, the journal of the American College of Chest Physicians, noted that with so many patients using them incorrectly, it was better for patients to get more corticosteroid treatment under the care of a physician. They strongly recommended better labeling and education about appropriate and inappropriate use.

Chlorofluorocarbons (CFCs) were used before 2011 as the propellant to deliver medication from many OTC asthma inhalers like Primatene Mist and prescription inhalers. CFCs were banned from inhalers by EPA to decrease ozone levels and do less environmental damage. As a result, Primatene Mist was removed from the market.

Asthmanefrin OTC Asthma Inhaler

Asthmanefrin (racepinephrine) is a CFC-free asthma product that is currently available for use that acts as a bronchodilator. It relieves asthma symptoms by relaxing inflamed muscles and functionally enlarging the airways of the lung. You should not use Asthmanefrin if you have any of the following conditions:

Asthmanefrin is a little different because it is not a traditional inhaler. Rather, the EZ Breathe Atomizer takes a small amount of liquid and turns it into a fine mist that can be inhaled into the lung. Once in the lung, it acts as a bronchodilator to improve your symptoms. The FDA warning about this medication's side effects should be monitored and if you use it, report any reactions.

Medical Organizations Opposed to OTC Asthma Inhalers

Not all professionals believe over-the-counter asthma inhalers like Asthmanefrin should be available to consumers. In fact, organizations such as the American College of Asthma, Allergy & Immunology, the American Association for Respiratory Care, the American Thoracic Society and the National Association for Medical Direction of Respiratory Care do not want OTC inhalers to be included in asthma treatment guidelines because they do not feel that over-the-counter epinephrine products are safe for the treatment of asthma.

A Word From Verywell

You will need to decide for yourself if this is an appropriate OTC treatment for you. You might be attracted to the lower cost and that you don't need to get a prescription. But these products are not the same as prescription inhalers. Asthma can be a life-threatening condition, and it needs to be discussed with your healthcare provider. If you have any questions about whether or not it is appropriate, please talk with your doctor.

Sources:

FDA. Drug Safety and Availability - Safety Concerns With Asthmanefrin and the EZ Breathe Atomizer. https://www.fda.gov/Drugs/DrugSafety/ucm370483.

FDA. Epinephrine CFC Metered-dose Inhalers - Questions and Answers. http://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm182381.pdf.

Mondal P, Kandala B, Ahrens R, Chesrown SE, Hendeles L. Nonprescription Racemic Epinephrine for Asthma. The Journal of Allergy and Clinical Immunology: In Practice. 2014;2(5):575-578. doi:10.1016/j.jaip.2014.02.014.

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