Many people use an OTC asthma inhaler for asthma like symptoms before getting an actual diagnosis of asthma. Asthmanefrin is currently marketed as an over the counter alternative to the Primatene Mist CFC inhaler, which is no longer available in the U.S..
CFCs Cause Ban For Primatene Mist
Chlorofluorocarbons (CFCs) were the propellant, or activating substance that forced medication from your asthma inhaler, in many OTC asthma inhalers like Primatene Mist and prescription inhalers prior to 2011. CFCs were banned in order to help decrease ozone levels and do less environmental damage.
The package insert for this OTC asthma inhaler states:
Asthmanefrin™ is an over-the-counter medication for the temporary relief of bronchial asthma, including shortness of breath, tightness of chest and wheezing. Asthmanefrin™ can be administered for patients ages four (4) and older. Asthmanefrin™ has been used to treat asthma in children and adults for over a hundred years.
The active ingredient in Asthmanefrin is racepinephrine, which acts as a bronchodilator. A bronchodilator relaxes inflamed muscles and functionally enlarges the airways of the lung. Enlarging the airway improves air flow and thus symptoms.
Asthmanefrin can be used for the temporary relief of asthma symptoms such as:
Asthmanefrin should only be used to inhale medication into the lungs through the mouth. Additionally, you should not use Asthmanefrin if you have not been diagnosed with asthma by a doctor, if a doctor has you on other asthma medications or if you have ever been hospitalized for asthma.
The package insert states that you should not use Asthmnefrin if you have any of the following conditions:
Asthmanefrin does not work like other inhalers. Rather, it uses a device like the EZ Breathe Atomizer that takes a small amount of liquid and turns it into a fine mist that can be inhaled into the lung. Asthmanefrin comes as a prepackaged single unit dose of 0.5 milliliters. The medicine is placed into the well of the atomizer device and the mist is the created and breather in. You continuously inhale until no more mist is created.
Not all professionals believe OTC asthma inhalers like this should be on the market. In fact organizations such as the American College of Asthma, Allergy, and Immunology; the American Association of Respiratory Care; the American Thoracic Society; and the National Association for the Medical Direction of Respiratory Care have not wanted OTC asthma inhalers part of treatment guidelines for asthma because they do not feel that epinephrine products are safe for the treatment of asthma.
These organizations question whether selling these medications over the counter is safe. While medications are moving to over the counter sales in some areas (allergy medications like Claritin or Alli the over the counter version of Xenical), we do not currently sell over the counter medications for hypertension, heart disease or cholesterol problems.
While I could not find specific studies looking at Asthmanefrin safety, there are several studies of its predecessor Primatene Mist. It appeared that Primatene Mist was safe when used appropriately. However, use was also associated with under utilization of physician services and other medications such as inhaled steroids.
In 2000 a report of the Council on Scientific Affairs American Medical Association concluded 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 report also stated that 20% of people using OTC epinephrine inhalers like Asthmanefrin have mild-to-moderate persistent asthma. These patients should be on other asthma medication and under the care of a physician.
You will have to decide for yourself what you think about this newest OTC asthma inhaler. If you have asthma symptoms you should see a doctor so that you can be diagnosed and treated appropriately.
- Asthmanefrin. Product website. Accessed September 24, 2013.
- Kuschner WG, Hankinson TC, Wong HC and Blanc PD. Nonprescription Bronchodilator Medication Use in Asthma. Chest 1997;112;987–993.
- Dickinson BD, Altman RD, Deitchman SD and Champion HC. Safety of Over-the-Counter Inhalers for Asthma. Chest 2000;118;522–526.