Gotcha, thanks.
Another tangential question (I have mild asthma. Dust really makes it kick in.):
Bitter tastants cause bronchodilation. That is, bitter tasting substances like quinine, if introduced into the lungs cause the bronchia to open up. The article writer specifically says “Given the need for efficacious bronchodilators for treating obstructive lung diseases, this pathway can be exploited for therapy with the thousands of known synthetic and naturally occurring bitter tastants.”
That was two years ago. Quinine is a generic drug. Hell, you can get it in tonic water. Its effects on the human body are thoroughly studied, and there are a whole bunch of chemically similar substances (chlorquine for one) available for more study.
Are we going to see a quinine inhaler on the market in the next decade? Would it do any good to get a vaporizer and some diet tonic water and go to town? It seems like it would be a very economical answer to a chronic and expensive health problem.
Something that I don’t get is why it is so hard to replace CFCs in asthma inhalers, when they were replaced in most (if not all) other aerosol applications decades ago; there are propellants that are non-toxic if that is the issue.
A propellant for inhalation has to be more than just non-toxic. The stuff is going into the lungs and absorbed rapidly into the bloodstream.
A LOT of things that are labelled “non-toxic” are not meant for ingestion.
~VOW
Some substances might also bronchial irritants even if both non-toxic and safe for ingestion.
WhyNot, let’s go through your concerns and see where we overlap and where we disagree:
Patient compliance: I definitely care about that, but we may disagree about compliance with what.
Encouraging patient autonomy and informed decision making: Exactly right. Many individuals are not informed about the risks of chronic BandAid asthma care. There have been many Sister Vigilantes out there, intelligent people who were actually at great risk of death because they were just plain not informed of either the risk of what they were doing nor of the availability of safer and more effective approaches.
Affordability of healthcare: Yup. Reducing preventable emergency room visits and hospitalizations saves us all money (even if an individual may, as Broomstick suggests, "save"money by stiffing the hospital.
And expanding, rather than constricting, treatment options: Here I completely disagree. Sometimes more restrictions are better care. Controls over unnecessary antibiotic use, over ineffective cancer care, so on. Personally I’ve always placed Primatene otc in that group. The fact that there has been an otc product that has much worse side effects and overall less efficacy than the products that are kept prescription for exactly the overuse concerns that I have expressed regarding Primatene has always struck me odd in the extreme.
Karl, ah I remember checking aminophylline peak and trough oh so well! What I thought was fun was learning that phophodiesterase cascade and then later learning, years later, that its clinical efficacy actually had nothing to do with that but was instead due to central and diaphragmatic effects. The peak and trough levels not so much so. It’s been amazing to me that fact that I have hardly any kids admitted or even needing the ER for asthma anymore; educated parents empowered with preventative meds and good action plans has cut them down to near zero. A long way from those days in the not so distant past.
Farmer Jane I apologize for what reads as a pot shot.
I’m ever so glad that patients on the North Shore of Chicagoland and in the Wisconsin penal system get better medical treatment than I. I should either get rich or get arrested.
Er, that didn’t sound snarky, did it? 
“Rescue inhaler” sounds so last ditch, especially when all I usually need is a little sumpin-sumpin to make me stop wheezing. And, contrary to the assumptions of many in the medical profession, which I assume were helped along by drug reps, heart rate goes higher for longer (starts on page 9) with Albuterol inhalers when compared directly with epinephrine inhalers.
You’re in Montreal, no? I seem to recall that it was Peter Macklem (at McGill) who demonstrated the essentially of the diaphragmatic effect of aminophylline.
I have a slight panic attack when my son is on his nebulizer. I’m always worried he’s in pain. For me, albuterol makes my chest thump like mad so badly it physically hurts. When I’ve been in the ER with asthma issues as an adult (mine is triggered by severe cold or the flu, with only the latter putting me in an ER), I end up with tears running down my face and coughing from the albuterol. That’s happened twice and I can’t believe that the nurses (both times, different hospitals) told me it was ‘normal’.
Thankfully, the stuff doesn’t make my son’s chest hurt. Still, I’m not a fan of it. I’m a bigger fan of epinephrine inhalers/stimulants. Unfortunately, the only thing I have in my medicine cabinet is OTC Bronkaid and an albuterol inhaler. If they take Bronkaid off the market I will probably die inside.
Well if you want anecdotes like I said Primatene is the only med I can count on to stop a sudden severe attack, it has mild stimulation as a side effect no worse than chugging a energy drink or coffee. I ended up in a situation similar to SV only with salbutamol(albuterol) which lead to that scary ER visit, I was using it excessively because it wasn’t working. Made me angry I listened to the anti-Primatene brigade 
It also had more varied side effects.
Hell I wouldn’t even mind if a epinephrine inhaler was RX only as long as I could have access, like I said no pharmacy stocks epipens here so the only other option is to go to the USA and get a script and bring it back.
grude, nah I’m not the one who wants anecdotes. Actually Primatene’s documented overall lack of comparable efficacy (relative to other more selective agents) has been one of the main arguments through the years to allow its continued otc status. The logic being that someone in a life-threateningly severe circumstance would not be able to effectively BandAid with something that worked so poorly and would end up getting the care they needed anyway. See this 2000 report of the Council on Scientific Affairs of the American Medical Association for example:
The same relative lack of efficacy is noted in in dropzone’s cite. Problem of course is as noted as my link goes on:
dropzone, Interesting cite. While a study of 8 nocturnal asthmatics is not exactly convincing it does make sense that its lack of specificity would cause vasoconstriction and thereby limit the systemic absorption (and the rapid degradation noted by that author).
Karl, just west of Chicago actually.
Hello. I just registered on StraightDope merely to comment on this thread. I’ve used Bronkaid/Primatene inhalers for 40yrs and my heart is ok. Now, since Primatene was removed from the market, my medical costs will go from $120/yr (6 OTC inhalers) to $660+ (8 ventolin inhalers + 4 required doctor visits to get a prescription). I’m presently unemployed and haven’t had health insurance since 2001.
My comment is about DSeid’s attitude. It sounds like he/she is some type of medical professional and their view of people taking care of their own health cannot be regarded as viable because there is no health professional holding their hand and permitting them to take care of their own health. It seems lately that more and more, no “lay” person has any individual rights to take responsibility of their own health without a medical “professional” person granting them authority to do so. But in fact, maybe unfortunately, the poorer you get the more a person does need to take responsibility for their own health.
Health care coverage is a privilege to people who can afford it. Many times it is not a priority for people who sometimes want to keep their house or eat. It’s very easy to state that a person would do better under “managed asthmatic care”; but for poorer people sometimes the only option is OTC drugs and the ER.
The only benefit I see with taking Primatene off the market is not a better environment (oh, c’mon now!) - but a boatload of profits to the doctor’s offices and the pharmaceutical companies that hold the patents - and a tightening (again) of the reins on the rights of individuals who desire/need/want to take care of their own health.
Please don’t respond by spouting some statistical study about the overall benefits of corticosteriod and beta-adrenergic receptor medication compared to epinephrine. If Primatene was in fact so useless, yet so detrimental to everyone who used it - it would of been taken off the market in the 60’s. The only way they got it off the market is similar to how Elliot Ness caught Al Capone for tax evasion not murder - subrogated guilt.
Have a good day everyone.
I am not a medical professional of any sort, just a person with mild intermittent asthma (with occasional flare-ups). While I can certainly sympathize with your financial situation, if you are needing 8 Ventolin inhalers a year, or 6 OTC inhalers, you are using the wrong drug to manage your asthma. In the past, when I’ve had more frequent flare-ups, my doctor recommended short courses of oral or inhaled steroids. My father, whose lungs are worse than mine, has used inhaled steroids for years.
Fortunately I haven’t needed steroids in quite a while now, so I don’t remember offhand exactly what drug I used or what it cost. I bet there are generics out there for at least some of them, though. (My doc used to give me samples if he had them.) And 4 visits a year for asthma management seems like a lot for someone who is purely using a rescue drug, unless there’s something else you haven’t mentioned going on. I see my doc maybe twice a year (once for a physical, and once for something or another other than that, usually my lungs or some other minor infection).
So I will be first in line to rant about how screwed up American medical costs are (I just found out the drug my ortho recommended for my screwed-up ankle costs $1100 in the U.S., but $300-some in Canada - for the same damn thing!), but maybe there is a way for you to manage your asthma better than your current way, for a lower cost than you are anticipating.
Nope. My inhaler has sixty puffs and I’m prescribed two puffs twice a day, though I usually limit it to one puff (more albuterol makes me sick). Even at my reduced dose that is twelve inhalers per year so Lianne22 might actually be UNDERdosing. And my albuterol prescription was the same when I was also taking Advair or corticosteroids as well as theophylline, which is still surprisingly expensive though it has been used to treat asthma for 90 years.
That’s an odd direction for albuterol. I rarely prescribe fixed dosing for my patients, nor is it generally recommended by asthma experts. Albuterol, as a rescue medication, should not be used unless one is having symptoms of an attack (exceptions can be made for exercise-induced asthma, when one might want to use it prophylactically, and in a few other circumstances.)
The idea is to get the asthma managed well enough so that the patient uses albuterol once a week or less.
You and my doctor are of the same mind on that subject. (And of the same mind as my dad’s doctor.)
Well I am please that I inspired you to register, if only to complain about my attitude.
I can see how you read it that way but obviously I see it differently. My take is that some aspects of health care significantly benefit from an active partnership. Patients should not left to manage their cancer care on their own, to treat a cold with an antibiotic, to prescribe their own insulin, or to treat and manage potentially life threatening asthma all on their own. IMHO. Sometimes access should be restricted.
dropzone may want to verify that such is how (s)he is supposed to be taking the meds, because that really is a very non-standard approach.
DSeid, you’ve already identified where we disagree - restriction of care options, even if some of them are suckier than others for some patients. I’m the flag waver for Patient Autonomy and Personal Choice, and Anti-Paternalistic medicine and Make Everything OTC (ok, 'cept antibiotics) and Let 'Em Kill Themselves if They Want.
Luckily, I have a genuine fondness for my nursing license, and I don’t say these things out loud to my patients *or *my doctors. 
It may be non-standard and non-ideal, but it’s also very common amongst certain patient populations (read: poor ones who can’t afford the best doctors). I just rechecked my med orders for my patients as part of my care coordinations…of 8 on albuterol, only one is PRN, the other 7 are 2 puffs BID.
I also have 5 diabetic patients, all on sliding scales, for what it’s worth, and zero on carb-counting and bolus insulin. I’ve got two patients on wet-to-dry dressings, which I’ve been repeatedly told by other nurses “aren’t done anymore”. There’s recommended and ideal, and then there’s what (some) doctors are actually still ordering.
I will chime in as well. My albuterol prescription says " 2 puffs every 4 hours", but that is not what I am supposed to do every day. I have to call my doctor if I use it that way more then once. Asthmatics are actually startlingly BAD at judging what medicine they need and when. Most of us cannot even detect bronchospasm until our airflow is measurably decreased, that’s why peak flow meters were invented. Poorly controlled asthma means you get used to inflammation in the airways and get even worse at detecting shortness of breath.
Well, he’s a DO. I’m just glad he doesn’t adjust my back to relieve my symptoms.
Another thought: for those whose asthma is triggered by allergies, many allergy drugs are super-cheap and OTC. Historically, since childhood I was always a person who refused to take any kind of medicine unless I was in truly dire straits. Not because I was uninsured or couldn’t afford the medicine, but just because I was of the philosophy that I shouldn’t need to take drugs all the time.
However, my lungs (and sinuses, for that matter) started behaving much better when after a series of stubborn sinus infections and asthma flare-ups, my doctor (gently) chewed me out and said (I am paraphrasing here, but not too much), “My dear, you have allergies. The reason you’ve been having all these sinus infections and asthma flare-ups is because lung irritation (and sinus congestion) are cumulative. If you actually treat your allergies regularly, instead of just when you feel like you want to die, chances are that you will have a lot less trouble with your sinuses and your lungs.”
So I said let’s give it a shot, obviously my current approach isn’t working too well, and I spent like $12 at Costco on a year’s supply of generic Claritin, and started taking it regularly. And I haven’t had a sinus infection or asthma flare-up in years. (Of course, I also quit the extremely stressful job I had at the time, which probably didn’t hurt either.)
Anyway, just a thought. $12 really isn’t much money, and no Rx required.