OTC Asthma Inhaler - Is It Safe?

by Kathi MacNaughton Health Professional

The recent reappearance of an over-the-counter (OTC) asthma inhaler called Asthmanefrin has stirred up the controversy between health care professionals and the consumer public about the safety of using such medication without the direct oversight of a physician.

A Little History on This Issue

Up until a few years ago, a product called Primatene Mist (and other generic equivalents) could be bought over the counter and used by anyone who felt they needed it. The active ingredient in both this older medication and the new Asthmanefrin was epinephrine.

Primatene Mist was taken off the market as a result of the CFC ban that was meant to protect the ozone levels in our environment. CFC stands for chlorfluorocarbons, substances used to propel the mist in an inhaler into your lungs.

There were no real concerns about the safety of an epinephrine inhaler, per se, when used as recommended in the package insert. But there are deaths associated with the use of such OTC inhalers, for a few different reasons:

  • People overrused the inhaler and suffered severe side effects.

  • People used the inhaler for temporary relief instead of getting more effective and longer-lasting preventive treatment such as inhaler steroids.

  • People who had never actually been diagnosed with asthma used the OTC inhaler, instead of getting the right treatment for the right condition.

Once Primatene Mist and the like were taken off the market at the end of 2010, these issues evaporated. The only treatments available for asthma required a prescription.

Now that Asthmanefrin is available, all these former risks now exist once again.

Why Asthmatics Want an OTC Inhaler Option

You might think that, given the risk, people would not be flocking to buy OTC inhalers, but this is not the case. Many asthmatics DO want an OTC option

For one thing, people see it as a control issue. In other words, the asthmatic can "take control" of his/her disease and decide on the treatment without consulting a physican. This may appeal to some people.

Secondly, buying OTC may be viewed as more convenient and quicker than having to schedule a doctor's appointment and then seek out a prescription.

Thirdly, OTC medications are often much cheaper to buy than prescription medications, particularly when we are talking about asthma inhalers. A prescription inhaled steroid can cost more than $100 a month to buy. If you have a prescription insurance plan, this may seem like no big deal, but when you're paying out of pocket for all of your meds, it is definitely a big deal!

Points to Consider If You Plan to Go the OTC Rout. Be sure you know you have asthma. Just because you're short of breath or you wheeze doesn't mean you have asthma. Many other conditions may mimic some or all the symptoms of asthma. It's better to talk with a doctor about the symptoms you're having, so that you can get to the root of what's really going on.

2. Use caution with the frequency. Anyone who has asthma and must use a rescue inhaler, whether prescription or OTC, more than twice a week does not have proper asthma control. Rescue inhalers offer only temporary relief. They expand the lungs, but they do not treat the underlying inflammation that is causing the symptoms in the first place. If you fail to treat this underlying cause, then you are at high risk for more serious complications down the road, including:

  • Severe asthma attack

  • Hospitalization

  • Death

3. Be sure you understand the possible side effects of your OTC inhaler. Be on the watch for these side effects and know when to call your doctor for advice or further treatment.

In Summary

I'm not telling you that it's wrong to use an OTC inhaler. I was uninsured for 12 years and unable to always afford prescription medication for my mild asthma. I understand the temptation.

But I am telling you that OTC inhalers are only a temporary fix and definitely not the best long-term strategy for treating asthma effectively. If you do make the decision to use them, then do so with full knowledge and caution and the readiness to go the prescription route when the time is right.

Kathi  MacNaughton
Meet Our Writer
Kathi MacNaughton

Kathi is an experienced consumer health education writer, with a prior career in nursing that spanned more than 30 years — much of it in the field of home health care. Over the past 15 years, she's been an avid contributor for a number of consumer health websites, specializing in asthma, allergy, and COPD. She writes not only as a healthcare professional, but also as a lifelong sufferer of severe allergies and mild asthma, and as a caregiver for her mother with COPD.