Why isn't albuterol (for asthma) over the counter?

[Kamino_Neko]

@WhyNot

But albuterol is indeed not without risks and side effects. It acts much like a stimulant, and raises the heart rate and blood pressure.

Anecdotal expansion of this: Last time I was in hospital for breathing problems (2 years ago! Longest I’ve gone without being admitted in a long while…), they had me hooked up to a monitoring device - measuring blood pressure, heartrate, and so forth - as well as administering Salbutamol (same stuff, different naming system).

A few hours in, a nurse finally thought to turn off the warning signal on the monitor, because every time I’d take my salbutamol, my BP and heartrate would shortly get high enough to set it off. I’d sit there watching my numbers go up, up, up…then beepbeepbeepbeep.

[grude]

@Kamino_Neko

Anecdotal expansion of this: Last time I was in hospital for breathing problems (2 years ago! Longest I’ve gone without being admitted in a long while…), they had me hooked up to a monitoring device - measuring blood pressure, heartrate, and so forth - as well as administering Salbutamol (same stuff, different naming system).

A few hours in, a nurse finally thought to turn off the warning signal on the monitor, because every time I’d take my salbutamol, my BP and heartrate would shortly get high enough to set it off. I’d sit there watching my numbers go up, up, up…then beepbeepbeepbeep.

That was one of the reasons why they always said Primatene was bad, that the epinephrine in it would raise blood pressure.

But if I needed a rescue inhaler one puff off a Primatene and I was fine, maybe felt like I drank half a cup of coffee or something if that. Albuterol/salbutamol inhaler I’d have to take at least two usually more puffs and I’d feel bad, like BP high and sweating and nervous. I honestly had worse side effects off it.

[Cartooniverse]

@GrumpyBunny

A hint from a fellow asthmatic: I used to forget one or both of my maintenance inhaler doses until I started to keep the inhaler (I use Advair now) by my toothbrush and toothpaste. Now I use it AM and PM before I brush my teeth. Bonus: you don’t forget to rinse your mouth after using the steroid spray!

I was born not breathing properly. Had chronic asthma from birth to age 6. As an infant and toddler, the stock response to a severe asthma attack was to hospitalize me in an oxygen tent. ( When training to be an E.M.T., I learned how serious a drug Oxygen is and what Oxygen oversaturation can do to a person. Holy crap. I’m lucky to have made it to 10… )

How wrong-way was some of the thinking on this in the early 1960’s? My parents had zero carpeting, because dust was considered an evil. Vinyl window shades, no curtains in the house anywhere. We were fairly poor, and yet I had an air conditioner in my bedroom window to control the humidity in the Philly summers. At the same time, we had 2 Siamese cats. And my Dad smoked in the house. Go figure.

Then at age 6 it went away for 16 years. Quite weird but true. It came roaring back with a vengeance on a particular ( pun intended ) night when I was forced to inhale particulates that were fairly dangerous for quite a few hours. I was 22 then and working on the Billy Joel music video " While The Night Is Still Young ". We had filled the main stage with thick fog effect using a DynoFogger at the old Camera Mart Stages ( formerly the Fox/Movietone Stages, then Camera Mart, then Sony, now much missed ) on West 54th St. I started wheezing and that was that.

At 52, I very rarely have an attack. I know the environmental triggers that get to me and try hard to avoid them. Back in the day, I relied on an inhaler several times a day if things got bad. I took allergy shots to “control” the asthma. ( Yeah. In quotes. What utter bullshit that was… ).

I am replying by using the quote above because it surprised me so much. My baseline side-effect was immediate and pronounced tachycardia. I’d be quite cranked for at least 20-30 minutes after a 2-puff treatment. Agitated, heart racing, etc. Taking it near bed time meant I was having a serious attack. Now, I must say, I had no other treatments prescribed to me. No maintenance pills, etc. No clue why. Guess it was that the Allergist put so much stock in those phials of allergy serum he shot me with that he figured the inhaler was all I needed.

I have one sitting in my backpack right now a few feet from me. It’s probably 2 years out of date, but I always have one on hand. Just in case.

ETA: In light of the post just above mine, I must say it was always albuterol. Either Proventil, or the generic once it went off-patent.

[CC]

Maintenance medicines are not always necessary or even desired. I’ve had asthma for 60 years. As a kid, I got it while shoveling snow, i.e. cold and exercise induced asthma. That was the only time I’d get short of breath and at that time there was an under-the-tongue med that I’d take. It had the same effect as the rescue inhalers do now - increased heart rate, excitement, and virtually immediate breathing relief. Now I’m an old fart and I’m taking several maintenance meds for a variety of conditions. **I don’t want any more things to take **and, frankly, I don’t really need them. I still get short of breath if I walk a lot in cold weather, or if I play a particularly vigorous game of racquetball. Both of those events are rare, so my inhaler is probably two years old by now and still has lots of shots left in it. My two cents…

[grude]

@CC

Maintenance medicines are not always necessary or even desired. I’ve had asthma for 60 years. As a kid, I got it while shoveling snow, i.e. cold and exercise induced asthma. That was the only time I’d get short of breath and at that time there was an under-the-tongue med that I’d take. It had the same effect as the rescue inhalers do now - increased heart rate, excitement, and virtually immediate breathing relief. Now I’m an old fart and I’m taking several maintenance meds for a variety of conditions. **I don’t want any more things to take **and, frankly, I don’t really need them. I still get short of breath if I walk a lot in cold weather, or if I play a particularly vigorous game of racquetball. Both of those events are rare, so my inhaler is probably two years old by now and still has lots of shots left in it. My two cents…

A lot of doctors will absolutely insist until they are blue in the face that if you have asthma attacks, even very rare or intermittent ones, you NEED to be on maintenance meds. That you should never even have an asthma attack at all, and that you shouldn’t even need a rescue inhaler. That if you are getting asthma attacks at all you have constant inflammation and if you can control that you won’t have attacks.

I’ve heard Primatene Mist was the work of Satan himself so much I laugh.

Then when you take the maintenance meds and you are still having the same amount of attacks, they keep bumping you up until you are on oral prednisone. Then steroid injections and the side effects are hell and you’re bloated, but you’re still having attacks at the same frequency. That was the point I said forget this I’ll just use Primatene Mist as needed.

I was really glad I discovered Claritin/loratadine though, that humble allergy med taken daily has pretty much wiped out asthma attacks for me.

[dstarfire]

Getting back to the original issue, another reason for regulating medications is the potential damage from accidental misuse. There are many substances where the difference between poison and cure is all in the dosage.

Also, some medications that are fairly safe on their own become dangerous when combined with others, or even certain foods.

You don’t want people taking either of those types of medication without the supervision of a medical professional.

[Sister_Vigilante]

I have had asthma since age 5. My pediatrician put me through a whole series of tests to confirm this, only to have absolutely no idea how to treat it. I was given a number of solutions. One was chiropracty (!!!) Then I was prescribed a pill that I had to crush in a mechanism and then breathe in the powder. It made me sick and didn’t help.

My parents finally gave up on this pediatrician and got me the Primatene. I lived on that for years. It got to where I was keeping it under my pillow for when I needed it. Couldn’t take it to school, so I couldn’t participate in physical activity at all. The teachers always wanted me to lie down on some couch somewhere. Guess what, lying down does nothing and aggravates the condition.

Hit age 20 or so, got bronchitis, it would not go away so they finally took me to the ER when I couldn’t breathe. (Yeah still lived at home.) It felt like my lungs were too full to take in air so I was breathing at the high end of the spectrum; could not exhale all the way.

Finally got a doctor who knew what asthma was, and prescribed me accordingly. I have albuterol for emergencies in my purse. But my savior is the Advair by my bed, which I take once a day. I can’t remember the last time I needed the albuterol.

[grude]

@dstarfire

Getting back to the original issue, another reason for regulating medications is the potential damage from accidental misuse. There are many substances where the difference between poison and cure is all in the dosage.

Also, some medications that are fairly safe on their own become dangerous when combined with others, or even certain foods.

You don’t want people taking either of those types of medication without the supervision of a medical professional.

You mean like acetaminophen? Just double the advised dose can cause liver damage, I think exceeding four grams a day gets you there.

A lot of liver transplants are because of APAP induced liver failure.

Not trying to be hostile but there are some very dangerous drugs OTC now that no one questions being available.

[WhyNot]

@grude

You mean like acetaminophen? Just double the advised dose can cause liver damage, I think exceeding four grams a day gets you there.

A lot of liver transplants are because of APAP induced liver failure.

Not trying to be hostile but there are some very dangerous drugs OTC now that no one questions being available.

*Lots *of people question Tylenol being available. I think the only reason it still is is that we don’t have another good option for OTC pain control in people with bad kidneys. As soon as one is made available with a safer profile than Tylenol, I bet you a million imaginary dollars that Tylenol is made prescription only.

[CC]

@grude

…Not trying to be hostile but there are some very dangerous drugs OTC now that no one questions being available.

It’s been said many times that aspirin would never be approved as an OTC drug if it were invented today.

[Mama_Zappa]

@WhyNot

Well, that’s the big three right there. You’ve asked a question that’s kind of like, “Other than the taste, convenience and cheap price, why do people like fast food?”

… People just don’t register “inhalers” in the same spot in their brain they store “medicine”. And so they don’t place the same importance on using their maintenance inhaler that they do, say, their statin pill.

The tl/dr rephrasing of the above: “cuz peeple is stupid sometimes”

The other lesson from that is “WhyNot knows her stuff, listen to her!”

I remember when the study came out in the early 90s about the strong correlation between rescue inhaler usage and asthma deaths. The way it was phrased at first was suggestive that the inhalers CAUSED the deaths; my doctor and I both agreed that it was because it meant the asthma was poorly controlled - i.e. correlation not causation.

People have vented about the cost of albuterol vs. the preventive meds. It’s because the albuterol was out of patent and available as a generic, where most of the preventive meds are several years away from that status. Albuterol has (I gather) gotten pricier because of the inhaler propellant changes; I’ve got decent insurance so I’ve been isolated from the cost.

Insurance can also be funny about the preventive meds. A couple years back, I was forced to switch due to my old standby going off formulary for no apparent reason (then being silently added back a few months later as I think the company realized how badly they’d screwed up). In any case, a month of my Flovent is something like before any reimbursements - ouch. Skipping it would send me to the ER and cost them a WHOLE lot more than 250.00. I sure wish they lumped that kind of thing into the “preventive” category which would let it bypass the deductible!!

As a side note on inhaler usage: I am amazed that more doctors don’t know about a gadget called The Doser. It registers when you take a puff, and can display a month of history. Used on a preventive inhaler, you can tell when you may have forgotten to take it. Sadly, it’s hard to find - drugstores can’t even order it any more, most of the online outlets no longer exist or no longer carry it. I can still get them directly from the company.