Quick-relief inhalers I: Over the counter (OTC) medications

Health Professional

Readers of this site have asked several important questions about the use of quick-relief ('rescue') medications -- both OTC and prescription. In this and my next entry, I would like to address the following issues:

This entry: Are OTC drugs an effective way of treating asthma?

Next entry: When is the right time (and how often) to use prescription quick-relief inhalers?

For people with mild asthma that only affects them intermittently, an OTC quick-relief medication may be reasonable. This applies to individuals who need no regular daily medication for their asthma and have symptoms less than twice a week during the day or twice a month at night.

There are two main formulations of OTC quick-relief medications -- inhaler and tablet. Both are drugs that are bronchodilators (relax the smooth muscles around the breathing tubes to let air go in and out more easily).

The main medicine in the inhalers (which include Primatene Mist, Asthmahaler) is epinephrine, also known as adrenalin. This is the same medicine as that in bee-sting or anaphylaxis kits for people with severe food or bee-sting allergies (e.g. EpiPen). It provides fast relief of wheezing but lasts only a few hours. It also can cause an increase in heart rate and blood pressure -- some patients may feel that their heart is beating in their chest and feel a little jittery.

Because it stimulates the heart, it should be used carefully and no more frequently than every 4 hours. Most importantly, you should contact your doctor if you need to use OTC rescue inhalers more than 6 times in a day or for more than two days, as this suggests an asthma attack that requires prescription medication and medical evaluation.

The main medicine in the tablets is ephedrine, a bronchodilator that can be taken by mouth and absorbed through the stomach. The onset of action is more gradual, and effects last a little longer than the inhalers, but since the drug needs to go through the bloodstream to get to the lungs, people tend to feel the side effects a little more than for the inhalers. The same precautions as for OTC quick-relief inhalers should be taken into account when using tablets.

Recent news on OTC quick relief inhalers

There are several legitimate concerns that have been raised about the continued availability of epinephrine-based OTC quick-relief inhalers: patient safety and the environment.

Clinicians who take care of asthma patients all understand that education and access to the right medications are key to good asthma control. However, many doctors and nurses are concerned that overuse or misuse of OTC epinephrine-based inhalers could be harmful to patients. Since these inhalers work very quickly (but don't last very long), they can give patients a false sense of asthma control. In this regard, it could delay patients from seeking care from their doctor as their asthma is getting worse, where prescription quick relief and longer-acting controller medications are the best treatment for poorly controlled asthma.

As currently available OTC quick-relief inhalers use cholorofluorocarbons (CFCs) as propellants, they are slated for discontinuation to remain compliant with international agreements to remove ozone layer-depleting chemicals from the marketplace. In September 2007, the U.S. Food and Drug Administration (FDA) announced that it would likely recommend that CFC-propelled quick-relief inhalers be fully phased out by the end of 2010. This means that unless manufacturers of OTC quick-relief inhalers change to a different propellant, they will no longer be available to consumers. While this may seem unfair to asthma patients, it should be clear that there are many quick-relief medications that are available with the advice of your doctor.

Closing thoughts

Asthma is a disorder that can only be diagnosed by a trained professional -- a doctor, physician's assistant, or nurse practitioner. While it may be tempting to 'avoid the hassle' of seeking medical advice and use OTC rescue medications for suspected asthma, you should get the advice of your primary care provider so that you can be sure that you are using any OTC quick relief medications correctly.

Read Quick-relief inhalers II: Prescription medications