Just curious because I don’t think I have ever met a asthmatic in the USA who didn’t have their ass saved by OTC Primetene at least once. You can do everything right but just forget your rescue med on a roadtrip etc.
I was just curious if any numbers had come in yet six months later, the daily death toll from asthma was shocking BEFORE it was removed so I was wondering what the situation is like now.
Anectodal, but I’ve never touched Primatene and I’m asthmatic. Of course, I’ve never ended up in the ER from asthma anyway; mine is pretty mild. But my albuterol inhaler lives in my purse anyway - never left it at home.
Perhaps it didn’t save many lives, but instead saved many trips to the ER? That’s what happened to me. (I had to convince that guy to take an out of state check – I told him I’d pass out in his store if he didn’t let me, and he caved). Anyway, that’s probably better for most people’s long term health.
–Cliffy
Yea that is a possibility too, not that they are mutually exclusive. Which is why I was curious to see the numbers if they exist.
I didn’t even know it was taken off the market. Wiki article says it was a CFC issue, and that Armstrong Pharmaceuticals is working on a CFC-free product as we speak. But since it was patented 50 years ago, surely by now there must be other companies marketing an OTC epinephrine inhaler, aren’t there? I go see if I can find the answer myself and report back.
While helpful for some asthmatics in a pinch, Primatene was a sh***y asthma rescue drug, which improved waaaay too many folks just enough to enable them to avoid getting actual medical attention and getting on decent asthma maintenance drugs, which are what really saves lungs and lives in the long run.
Since the drug has only been off the market for less than 5 months, I doubt the numbers are there for the crunching yet, as to whether its absence is altering behaviors and outcomes yet.
Asthma sufferers have long relied on inhalers for relief from wheezing or coughing attacks. But as of Dec. 31, Primatene Mist – the only available over-the-counter asthma inhaler – was taken off shelves because of its adverse effect on the environment. Other inhalers are available, but these require a doctor’s prescription.
I’m an infrequent asthma sufferer, and I used Primatene as a rescue / preventative at times. I’m definitely annoyed it’s off market, although I suppose it’s an excuse to actually get an albuterol inhaler.
Armstrong’s handling of the situation seems deeply irresponsible to me. Instead of readying a replacement, they publically stated no alternative existed and tried to encourage a letter-writing campaign to change to law. Once hope ran out on that and the law went into effect, they announced that now they’ll make a non-CFC version.
Maybe it’s because the CFCs were the only effective ingredient in Primatine.
Question that just popped into my brain: if somebody were having an anaphylactic reaction and didn’t have an Epipen handy, but did have a Primatene inhaler, could he start huffing on that instead? Would it have any effect?
Might work, sure. In code situations where the patient is intubated, it’s better to dump epinephrine down the ET tube then bag 'em like hell than it is to try to push it IV. Rapid absorption in the lungs, then right to the heart & brain, as opposed to slow travel through the venous system.
No, it’s definitely the epinephrine that does the job. Giving shots of epi is still effective if you’ve a really tight asthmatic who’s looking like he’s about to crash, and no albuterol nebulizer handy.
For that matter, why the eff isn’t there a generic HFA *albuterol *inhaler yet? That’s the med most “noncompliant” among my patients, because it’s just too expensive for most of them. [/grumpy nurse]
My WAG is with QtM’s implied one: if anything removing that crap from the marketplace will save lives.
The op’s position seems to be that the best thing to do if someone has a life-threateningly severe asthma flare, or multiple such flares, is to go to a drug store to get an otc resucue inhaler and the absence of that might actually force people at risk of dying from that particular flare to go to an emergency room instead. Which somehow will be more likely to make them die than using a crappy inhaler that is clearly insufficient care for such a serious episode.
If someone is having a life threatening asthma episode they should be in an ER, or at least at a doctor’s office. A choice to instead be in the check out line in the drug store might really be checking out, no lying.
Okay. So that is not what people are really upset over. The reality is that many people would rather keep using a crappy otc inhaler over and over again, several times a week, maybe once a night every other night or so, than have to go to a doctor who will tell them that their asthma is chronic and uncontrolled, that they need to be on some controller medicine every day, and that such reliance on and overuse of a rescue inhaler is setting them up TO DIE from their asthma.
Out of town and forgot your rescue inhaler and having an infrequent moderate episode that is not potentially life threatening? Guess what? Your doc can call a prescription in across state lines. Really have very mild and infrequent asthma. Really no big deal to get a rescue inhaler script once a year.
My experience is that people don’t go to the drug store, but keep the rescue inhaler around. And I don’t know about anyone else, but in the rare times when my sister has had problems like that, she took the inhaler, and if she didn’t return to normal functioning, she went to the hospital. (Though, with her insurance skimping on the last bill, and leaving us in debt, I wonder if she’d be more reticent to go now.)
If you *have *a doc. If you can afford a “just in case” doctor visit and inhaler you may not use before the expiration date. If you’re not paranoid about having an asthma diagnosis on your medical record for future insurance companies to look at when deciding coverage and rates. (And yes, I do hope that a couple of those barriers come down with the new health care laws, but we’re not living in that world yet.)
I’ve had two episodes of wheezing in my life. I don’t have asthma. I don’t have COPD. I don’t have reactive airway disease or chronic anything at all. I had a bad bout of wheezing brought on once by cold air and exertion (shoveling snow) and once by seasonal allergies and heat/humidity - totally unrelated conditions, separated by several years, totally fluke events (so far.) A puff of Primatene and that’s the end of the story.
Would you prescribe me an albuterol inhaler based on that history? My doctor won’t.
Uh-huh. And if you don’t have health insurance getting in to see a doctor can be very difficult, and paying for daily meds out of your own pocket may or may not be affordable depending on your financial situation. Which leaves our hypothetical asthmatic with NO care outside of an ER and emergencies.
Which, as is so often the case, gets back to how effed up medical “care” is in the US.
It doesn’t do jack for a doctor to prescribe a daily medical regimen if you simply don’t have the money to buy the meds, and that’s assuming you can afford regular doctor visits in the first place.
I’ve had people verbally rake me over the coals because I go to a “mere” GP instead of a pulmonologist, but the fact is my insurance won’t pay for me to see a specialist because my asthma isn’t bad enough to qualify under their rules. I simply can’t pay for it out of pocket, unless I can give up eating for the rest of the month. Fortunately, I do have relatively mild asthma and my doc is up to keeping an eye on my asthma and allergies. I have no doubt he’d refer me if ever I got worse than the scope of what he can handle. Unfortunately, if the insurance won’t cover it I’m not sure how I’d be able to go to one. Maybe I’d be here on the Dope asking for people to pitch in for me or something. I’d hold spaghetti dinners or something in my neighborhood. Beg, perhaps.
My understanding is that in at least some other countries it is possible to get an OTC albuterol inhaler. I’m not sure of the details, I think you may have to actually talk to the pharmacist. Apparently, other countries manage to have an OTC/non-Rx option for asthmatics but then other countries also manage to provide healthcare for all their citizens and don’t think routine bankruptcies due to medical bills is acceptable.
Having your doc call in a prescription? Sure… just so long as it’s not on a weekend, a holiday, he’s not vacationing in Australia, or tied up with an even more dire emergency.
The concern in the op is that the lack of Primatene will cause deaths rather than prevent them. So let’s take your hypothetical individual with no regular health care provider and who believes that the cost of an annual primary care visit and albuterol puffer is too much money, or who is too paranoid about having “asthma” as a diagnosis on their record. Who has a life threatening episode which would kill them without adequate care. Is the easy availability of an inadequate approach for such a serious circumstance likely to save his/her life or to cost him/her it?
(Same response to Broomstick. And noting that doctors practices do take calls even on week ends and holidays.)
Not an adult doc. A kid with very rare episodes of reactive airways? Sure, they could call for one when they need it. After I got a more complete story to be sure that there is not some more to the story than the thumbnail presents. If they needed it more than very rarely I might want to look into things more though.
And as relevant to the op: your one puff of Primatene end of story did not save your life. It saved you annoyance and inconvenience. The op is claiming that lives will be lost; I am claiming lives will be saved. If it turns out that a few people are annoyed or mildly inconvenienced in the process I really could live with that.
Big T, IF she had a decent relationship with a good primary care doc she would have a real asthma action plan. You’d be amazed how effective such a thing is at avoiding the need to end up in the hospital. If someone instead uses Primatene here and there, and when it does not work goes into the hospital, and never develops that asthma action plan, they are not saving themselves any money. The hospital visit is serious bucks; the doctor’s office visit relatively not so much so.
My SIL just posted about my brother’s asthma on FB recently. The jist of it was this:
So…for my brothers and myself who do use OTC drugs sometimes to help with our asthma (they have it 10x worse than I), I disagree with the notion that “oh, taking this drug off the market will SAVE lives” because I don’t know how many times I went without medical care just because I couldn’t afford it.
Btw, I use the stuff in the pill form and I love it. It’s a preventative, not a rescue inhaler, but I’m glad that’s still available, even if I do have to whip out my ID and fill out paperwork before I can buy it.
My brother and my son and I all have asthma and we live near one of the greatest asthma care centers in the country but we’ve never stepped inside. Not everyone has access to healthcare. And even some of us who do, don’t have access to good or affordable healthcare.
Not quite sure how that upset over the cost and the decision to be uninsured with a baby on the way lead to the conclusion that Primatene otc saves lives rather than costs them.
Walk me through it. Do you believe that your brother is at risk of death from his asthma and that using a Primatene puffer would save his life? Do you not believe that there are some who use Primatene here and there, sometimes quite often, rather than see a doctor and come up with a plan for dealing with asthma episodes that controls it better, reducing the risk of emergency room visits, hospital stays, or even death?
Don’t get me wrong. I completely agree that the cost of having preventative care is a barrier, and one that ends up costing all of us more (in emergency room and hospitalizations costs if nothing else). Even large co-pays for asthma prevention meds can be counter-productive in terms of containing costs. Affordability and access to decent enough healthcare is a major issue. But asthma deaths are not avoided by using Primatene here and there or more; they are avoided by having those who need to be on a preventative med stay on it and by having a real asthma action plan in place.