Is OTC Asthma Inhaler Medication Available in the US?

OTC Meds And Your Asthma

Over the Counter Asthma Medication- Primatene Mist
Over the Counter Asthma Medication- Primatene Mist. Photo © Davis McNew Getty Images News

Are over-the-counter asthma inhaler medications available in the United States? Asthmanefrin (racepinephrine) is a currently available OTC inhaler medication for asthma. These types of asthma medications are designed for the temporary relief of asthma symptoms such as shortness of breath, chest tightness, and wheezing.

Concerns About OTC Asthma Inhalers

The FDA has warned patients of the potential harm of using Asthmanefrin with the EZ Breathe Atomizer.

They have 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.

Chlorofluorocarbons (CFCs) were used prior to 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.

Are Prescription and Over-the-Counter Asthma Medications Different?

Over-the-counter inhalers may only be effective in people with mild intermittent asthma. In people with anything other than mild intermittent asthma, prescription medication is necessary.

Prescription asthma medications like Flovent or albuterol can only be obtained from your asthma doctor.

Over-the-counter asthma medication can be obtained without a prescription or a visit to your doctor.

Over-the-counter asthma medication inhalers may taste different than prescription inhalers. Also, patients reported that over-the-counter asthma medications like Primatene Mist feel different when inhaled, compared to prescription inhalers.

Prescription inhalers also cost significantly more than over-the-counter asthma medication, which makes them an attractive choice, although perhaps at a cost of them being less effective.

Is Over-the-Counter Asthma Medication Safe?

A number of safety concerns regarding the sale of over-the-counter asthma medications have been raised by the medical community. Over-the-counter medications are not sold for hypertension, heart disease, or cholesterol problems, and the U.S. does not allow people to purchase medication without a prescription as many other countries do. As a result, a number of researchers have studied whether or not this practice is safe. The FDA has issued a warning specifically for Asthmanefrin and its EZ Breathe Atomizer.

Over-the-counter asthma medication appears safe when used appropriately. An article in the journal Chest found that "the occasional use of OTC epinephrine inhalers appears to be safe and effective when used according to labeled instruction by individuals with only mild, intermittent disease." However, the article also found significant numbers people using over-the-counter asthma medication were using the medication inappropriately. Using over-the-counter asthma medication was associated with under-utilizing both inhaled steroids and physician services.

Who Should Use Over-the-Counter Asthma Medication?

Anyone who feels they need to use an over-the-counter asthma medication should probably see a doctor about their symptoms. Asthma is a serious disease that can get worse quickly and asthma may not be causing your symptoms.

According to the packaging for Asthmaferin for example, you are specifically instructed:

  • Don't use it unless you have been diagnosed with asthma by a physician.
  • Don't use it if you are taking a prescription monoamine oxidase inhibitor (MAOI) as is often prescribed for emotional conditions or Parkinson's disease.
  • Don't use it without discussing it with your doctor if you have certain other problems, like heart disease, high blood pressure, diabetes, thyroid disease, seizures, and psychiatric conditions.

    Just because a medication is available over the counter does not mean that you should use it. An over-the-counter asthma medication has risks and side effects just like other medications. In fact, a significant number of emergency room visits are due to side effects of over-the-counter medications.

    Sources:

    FDA.  Epinephrine CFC Metered-dose Inhalers - Questions and Answers

    Drug Safety and Availability - Safety Concerns with Asthmanefrin and the EZ Breathe Atomizer. U S Food and Drug Administration. https://www.fda.gov/Drugs/DrugSafety/ucm370483.

    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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