I work as an EMT at a Las Vegas resort, and one of my duties is to handle referrals to doctors through our worker’s compensation program. One guy I come into contact with frequently has been suffering severe asthma attacks that leave him basically crippled in a back room sucking on his prescribed albuterol nebulizer. Sometimes this isn’t enough, and he’s still wheezing even after taking the full dose. It has been pretty scary sometimes, but he never lets me get him to a hospital, and as long as he’s still conscious and alert I can’t make him do anything he doesn’t want to do.
So, long story short, this guy went to his doctor to ask if there was anything else he could use to treat his severe asthma attacks, and the doctor gave him an EpiPen. I’ve never heard of epinepherine used for treating anything other than anaphylaxis, and only as a temporary way to stabilize someone enroute to a hospital. I checked out the EpiPen entry in the physicians desk referrence, and found no indication that epinepherine is useful for treating asthma. Has anyone else heard of this?
As far as I know, Epi-Pens are prescribed for asthmatics who can be triggered by allergies, particularly food allergies. As far as I know they are, indeed, only intended to be used so you can live long enough to get to a hospital.
The rule of thumb is that if you need to use your albuterol more than twice a week something is wrong and you need either a long-acting medication (or two, or more) or your medication needs adjusting. Some people really are so bad off as to be having daily attacks no matter what, but that’s unusual
As you say, as long as he is conscious there’s not a hell of a lot to be done without his cooperation.
Epi is a useful emergency rescue medicine for acute asthma regardless of what triggered it. I’ve given it on a number of occasions, but I must admit usually constant albuterol & atrovent nebulizations and oxygen work better. But epipens, if used, should be used in the context of a real medical emergency, with immediate followup with a medical professional.
Otherwise, sounds like this guy needs some maintenance med adjustments. Inhaled steroids, long-acting bronchodilators, leukotriene inhibitors, maybe even systemic steroids may all need to be employed.
Yep, that’s right! The FDA allows epinephrine to be sold over-the-counter. Never mind the fact that it doesn’t help much in asthma, and there are tons of better medicines out there…
I pity the Las Vegas resort that uses a doctor who thinks EpiPen is second line med for asthma though.
Perhaps his physician is trying the EpiPen to see if the patient is having attacks of severe bronchospasm triggered by an environmental exposure to an inciting allergen in the workplace. Such reactions can be severe, and injectable subQ epinephrine would not be an inappropriate drug with which to treat it.
Since the patient won’t get formal medical evaluation and therapy during an attack, I’d be hesitant to look in from the outside and criticize what’s going on–only the patient knows what conversation was had with his doctor.
Right - but none of those “better medications” are over the counter. If you’re traveling somewhere, don’t have your inhaler (not only can they get lost, if your purse is stolen or your pocket picked they can disappear that way, too), it’s the weekend, you can’t get ahold of your doctor, whatever, Primatene Mist may well relieve the attack long enough for you to get to a doctor or find your prescription and get access to those better medications. In an emergency it might mean the difference between a person remaining conscious versus passing out and perhaps suffering brain or body damage from lack of oxygen. Since the FDA won’t allow albuterol or the like to people without doctor’s say-so, even if they walk into a pharmacy clearly having an asthma attack, they allow Primatene Mist to remain on the shelves. Yes, it is abused by non-asthmatics and possibly some asthmatics as well but given that there is a role for it in emergencies it would be tragic for it to be pulled entirely.
As someone who once had my inhaler stolen on a Sunday morning only to suffer an attack in a city I was not familiar with I was quite happy to be able to walk into a store and buy a medication that would help me. After which I could go to a walk-in clinic and pay less than $100 to see a doc who set me to rights rather than going to an ER either with a full-blown potential life-or-death emergency or to wait for hours and hours and run up a bill of thousands of dollars. In view of that Primatene Mist is a bargain for everyone involved.
Actually since epinephrine is sold over the counter there was a lot of talk of letting albuterol to be sold over the counter. The basic argument against this was less about safety as it was about the fact if people get albuterol over the counter they won’t see their doctor.
The thing is steroids almost always work in real asthma. But they have serious side effects so you want to use steriods only when asthma requires it.
I have found people with bad asthma refuse to control it correctly. Hardly anyone uses the inhaler correctly. When I show them how to use it, they are always astonished. “WOW it really works that way.”
Second is even with a rescue inhaler you should NEVER have an attack. You always get warning signs your asthma is gonna flair up. THIS is when you use the rescue inhaler NOT after the attack is full blown.
My asthma was horrible at one point. I wouldn’t have enough breath to cross the street. One night I had to sit down in the snow, 'cause I couldn’t walk anymore. I started exercising. It took me TWO years to get up to running an hour. BUT my asthma improved so much, for the last five years, I don’t even use one rescue inhaler in a whole year.
It’s the epinephrine when you exercise that helps you. I feel a bit tight in my chest, I start exercising on a bike and within ten minutes I feel better and move to a treadmill and in 30 minutes, I feel great. Of course I have had years of practice, but asthma really is controllable, but you got to put in an effort and LISTEN to your doctor.
Untrue. Pulmonary function can go from normal to severe restriction in just a few seconds, with virtually no prodrome. Often, there are no useful warning signs of an impending attack.
Incorrect. That is true with intrinsic asthma, not with asthma due to external triggers. I don’t get a “warning sign” before someone steps into an elevator with me wearing a scent I’m allergic to, for example. My asthma is not the same as your asthma which is not the same as someone else’s asthma.
Frankly, I view ANY “sign” of asthma symptoms as an “attack”. I don’t wait for great, wheezy gasps for air. Symptoms=asthma=treat it promptly. Sorry if that wasn’t clear. Happy to say I’ve stayed out of ER now for almost 15 years, I must be doing something right.
On review - what Qadgop said.
I’m fortunate in that my triggers are specific and the worst ones CAN be avoided. Even so, the inhaler travels with me when I leave the house.
Not any more, although it’s not because of the adrenaline.
Speak for yourself. I have been prescribed ALL the rescue inhalers, and none worked effectively at treating an acute attack, or the constant asthma I get when I have a cold, flu, or bronchitis, or just from dusting and vacuuming the house.
But all the others are prescription-only, which means they are out of your reach if a physician is out of your reach, either because of travel or finances.
Just a suggestion - many years ago I went out and bought a mask to keep out the dust while cleaning. Not one of those piece of crap flimsy white facemasks, I mean one of those big rubber and filter things that make you look like a bug-eyed alien. Made housecleaning much less a trial AND I don’t need to use an inhaler after cleaning anymore, either. Well worth the money.
I’m also an EMT, and I’m allowed to use an Epi-Pen for a severe asthma attack with medical consult, usually in the case of the patient’s own inhaler not working or if they don’t have one. Any time an Epi-Pen is used, the patient is to be brought in to the ER for evaluation, according to my state protocols.
We have a protocol for intramuscular epinephrine (which would work similarly to an EpiPen), for patients with severe asthma. It tends to get used when other mess aren’t working.