![]() It is important to realize that asthma is on a continuum from mild to severe, and many patients may move from one category to another. They also recommend that patients not stop their prescribed medicine to take Primatene Mist. The FDA recommends that Primatene Mist is only appropriate for people with a prior diagnosis of asthma and only those with mild symptoms of intermittent asthma (such as those with no more than two asthma attacks a week). The treatment approach to asthma is highly individualized and patients strongly benefit from a tailored approach from their allergist or healthcare provider, rather than relying on OTC medication. Well-known triggers such as exercise or allergies may cause acute symptoms and lead to inflammation in the airways. Symptoms include cough, wheezing and shortness of breath. With this new approval, it is a fitting time to discuss why allergists, both then and now, have discouraged use of this OTC treatment for the symptoms of asthma.Īsthma is a chronic disease that involves the airways of the lung. ![]() The Food and Drug Administration (FDA) has recently approved a newer version of this inhaler which instead of CFCs uses hydrofluoroalkanes (HFAs) as a propellant, similar to many prescription asthma inhalers. This was due to the propellants used in the inhaler, chlorofluorocarbons (CFCs), which are harmful to the environment and are no longer permitted. Though this is a discussion for another day, I have used racemic epinephrine extensively in bronchiolitis, including in continuous nebulization, and it is effective, with great outcomes, avoidance of intubation, and few or no side effects.Patients with asthma may recall that in 2011, an over-the-counter (OTC) asthma inhaler, Primatene Mist (epinephrine) was removed from the shelves. (I am not advocating PM use 104 times/yr, this is NOT my definition of step 1 asthma). No one except those who erroneously think that SABAs are dangerous, even when used appropriately, is recommending they never be used. Even epinephrine in Primatene Mist (PM -which can be found for less than $25) has been used safely by millions and it can, if fact, be used very sparingly for people with no insurance who have asthma symptoms that could truly be called intermittent, such as, very rarely, maybe 2 or 3 times or less (not 104 times) a year. Also, the cost of one generic budesonide/formoterol inhaler is more than $200.īy the way, short acting B2 agonists (SABA) are still a fine choice for step 1 treatment. Instead of asking the FDA to allow inclusion in the OTC market, makers of ICS/formoterol should focus on education campaigns to inform all asthma patients to obtain proper medical care, and to educate them about the dangers of self-medicating. "Intermittent" asthma can result in death, and now encouraging patients to self-medicate incorrectly at this level of symptoms is a pretty bad idea. To me that is still too frequent but better than allowing twice-a-week symptoms to go untreated.Ĭontinuing to accept the present definition of "intermittent" asthma and now proposing that patients should take care of this level of symptoms on their own by providing them with a "better" OTC choice of ICS/formoterol is still irresponsible. This is based not on science but an arbitrary threshold for very frequent symptoms. The more accurate GINA guidelines place step 1 treatment at symptoms that occur monthly. In the US, asthma guidelines allow for patients who have symptoms up to 2 times a wk (104 times a year) to be classified as "intermittent" and deemed not to need controller medications. ![]()
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