Well first off let me say I am guessing you don’t have asthma, because in a severe attack you aren’t going to be sitting in a doctors office you need relief NOW. You can say well you should have, or why didn’t you til you are as blue in the face as an asthmatic it doesn’t change the fact the world isn’t perfect.
Second off all you put a whole scenario in my mouth, namely that people should use primatene instead of being on controller meds and medical care which I never said. All I was curious about was numbers, but yes I do believe A rescue inhaler should be OTC like salbutamol at least.
And finally going without Primatene almost cost me my life, I have asthma attacks infrequently that only respond well to epinephrine. Primatene is useless as a controller med, but are you really saying it was better for me to pass out and only regain conciousness in the ER after being injected with epinephrine? I live on a mountain and don’t have a car, an ambulance couldn’t be dispatched in time to help and I was lucky some police were around to carry my limp body to the closest hospital, I very easily could have not been so lucky and it traumatized my wife so much she had nightmares. But I guess that is all my fault, should have…
Because I’ve tried nearly everything and despite being on controller medications I sometimes have an attack and the only med I can depend on to stop it is Primatene. Everyone can call it trash all they want, it works and the only advice doctors can offer is well just come back to the ER :mad: Epipens are not even available in this country, well guess its my own stupid fault for living here and I should know better.
Actually I do have asthma, albeit relatively mild excepting with cat exposure. Take my controller every day.
If you have seen a primary care doc and the only advice you’ve gotten is “well just come back to the ER” then you need to find a new doctor. I cannot intelligently comment on your particular case, but we have comparable circumstances in young children all the time (not well addressed by the current asthma care guidelines): infrequent episodes but very severe when they occur. A clear and well thought out asthma care plan is essential for those cases. How to monitor? How to have an early warning that a severe episode may be on its way? What medicines are justified and possible to have in the house? For these kids we often have parents with steroids on hand as well as a inhaled bronchodilator with a guideline for how to use, how to step it up, and when to call us (in addition to anytime they are worried or have questions).
(EpiPens are available btw. Prescription of course.)
The baby and pregnant mom are covered, but they don’t have regular full family insurance at the moment. Please don’t take pot shots at my brother.
I was just saying that Primatene and other OTC drugs can easily be a drug of choice for those who can’t go to the doc’s office at the moment. I’m not sure how you thought I was passionately adamant about Primatene staying on the market because it will otherwise cause death. I do think it SHOULD still be on the market, but anyway.
:dubious:
Just because some people don’t use a medicine as directed or don’t take care of themselves doesn’t mean everyone will do the same.
You are generally sympathetic to patients, DSeid, so I’m kind of surprised at your position here. I was just echoing with my own anecdotal evidence that preventative care isn’t always an option. I don’t even know if my brother has ever bought the medicine or not. I was going off my SIL’s FB feed here - since they don’t have insurance, a doc visit is extremely expensive. And all he has to do is walk in, give a history and get a “wellness exam” and a doc gives him a script.
It’s not a new diagnosis. He’s had asthma since he was…well, since forever. And because he needed a refill, he was out $150 for a joke of an exam (the clinic being the cheapest option - most people without insurance around here don’t go to family practices re: cost) plus the $15 or so the albuterol inhaler costs.
This med was taken off the market for environmental concerns. :rolleyes: Not medical ones. The medicine wasn’t directly harming anyone. And for people with mild asthma, Primatene may have just been the thing for them. I assume a different OTC drug for asthma will come in the future.
Not sure if I’m violating Doper rules, but…did you ever use ephedra regularly? Because when I was using that stuff for wait loss back in the day, I didn’t have asthma spell for months.
Maybe as a preventative you can take the asthma OTC pills?
No problem vacationing in Australia as a albuterol inhaler is fifteen dollars OTC, maybe my imagination but he CFC free abuterol doesn’t seem as effect as the old kill the environment formulation
If the office is closed you get an answering service that may or may not help you get in contact with the doc. The chance seems to be 50/50 of being told “go to the ER” rather than getting a number to reach the doc. If you’re having trouble speaking - which isn’t uncommon during a bad asthma attack - hope to Og they don’t just hang up on you thinking you’re a prank call. Oh, and if you have to navigate a voice-activated menu at any point? You’re f****** because they don’t deal well with wheezing.
If you are poor but don’t qualify for Medicaid you’ll have to cough up around $110 per office visit, plus the cost of any additional testing and medications. If you don’t have the money you won’t get any of it.
If you are that poor, and go to the ER in an emergency, they have to treat you - even if you can not pay.
So yes, they DO save their money, because the ER has to treat them even if they can’t pay whereas the regular doc and the regular pharmacy can refuse them if they don’t have bucks.
You are correct. I am not the OP, and I am concerned with more than saving lives, however. I’m also concerned with patient compliance, encouraging patient autonomy and informed decision making, affordability of healthcare and expanding, rather than constricting, treatment options.
And I’m still not clear how having a good asthma plan and strong relationship with a primary care physician out of state is supposed to relieve airway constriction in someone with an acute wheezing incident who doesn’t have asthma or scrip for an albuterol inhaler. A Primatene Mist inhaler in a friends’ pocket…that I understand.
Before I got on contoller meds, I took Primatene Mist for rescue-only. Eventually it stopped working; I would be keeping them all over the house and even one under my pillow. I was taking it every thirty minutes, my heart wouldn’t stop pounding. I ended up in the ER. I was there several days and had a pulmonologist who told me to stop taking Primatene immediately - that it’s really bad for your heart - and prescribed me a controllor drug and albuterol for rescue. It took about 4 weeks for my lungs to finally calm down.
Since then, I have used my albuterol … actually I can’t think of the last time I needed it. This was 20 years ago.
Now my only issue is that Advair costs a bajillion dollars and now I’m on my aunt’s supply (she won’t take it because she thinks it is going to kill her, as opposed to the chain smoking).
If you’re so well-controlled that you dn’t need your albuterol hardly at all, it’s time for your doc to consider ‘stepping down’ your therapy. Using the lowest amount of medication needed to keep one’s asthma in good control is a benchmark of appropriate asthma treatment.
I have moved many patients down from advair-type maintenance drugs to inhaled steroids alone (which are much cheaper) without having their asthma worsen. And if albuterol use remains once a week or less on stepped down therapy for 3 months or longer, one can consider stepping down even further.
Absorption is erratic, its ability to induce bronchodilation varies widely between individuals and even within the same individual depending on circumstance, its therapeutic window is relatively small, but if one is in significant respiratory distress due to bronchospasm and other options are lacking, it’s worth a try.
It’s my understanding that HFA (the non-CFC propellant) is still proprietary. Gotta wait a few more years until it becomes generic.
I use Albuterol, and I blew a cork when the pharmacy started charging me the NON-generic price. I pitched such a fit the pharmacist had to come to the counter and explain it all to me.
The manufacturers of Albuterol had received many extensions to the law which required the change from CFC propellants. It finally came down to the wire about five years ago, when the EPA finally said NO MORE. Since the drug companies had to “invent” the new propellant, it became a proprietary drug, and they got to charge a higher price for it.
As I told the pharmacist, “The drugs usually go from name brand to generic, NOT the other way around.”
Not as a rescue effort, but I have noticed that coffee will ease the tightness and/or chest pain I get sometimes as a symptom of my asthma. I think the temperature of the coffee (I like it scalding hot) also provides some relief.
~VOW
When I was in med school* and learned about the pharmacology of theophylline (and caffeine), I suggested to my mom that she try drinking coffee when she got “tight” (she had truly severe, sometimes seemingly intractable asthma). Lo an behold she swore it really did help. Ever after she made a point of telling anyone who’d listen how clever her son was (and why had none of her asthma docs ever mentioned it?).
Oh, there’s definitely a connection, I’ve given newborns caffeine in the PICU for neonatal periodic breathing as an alternative to aminophyline, and I’ve seen data on reduced symptoms of asthma for regular users, but I’ve never talked to someone that had a good rescue experience.
Another tangential question—I take propranolol once or twice a month for stage fright. Ninety-five percent of the time I have no issues whatsoever. The other one time out of twenty though, I experience a mild tightness in my chest and the subjective impression that I can’t take in a complete breath, which usually starts several hours after I’ve taken the propranolol. Should I mention this to my doctor?