OTC inhalers to be phased out to protect ozone layer

Inhaled epinephrine (Primatene and other brands) can actually be quite dangerous, more so than related prescription asthma inhalers (so-called beta-agonists).

This is a good thing to ban for safety reasons. It's been OTC for so long because it was more or less grandfathered.

Xelebes said:

The aerosol inhalers have always been generally ineffective for me. The powder-pulls (like Symbicort) have been multiple times more effective and prevent any need for a rush to the doctor.

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Symbicort (and similar Advair) are actually combinations of a long-acting steroid and a long-acting beta agonist. They are intended to be used in a different way than simple, shorter acting beta agonists like albuterol (Ventolin, Proventil, many others)

Xelebes said:

So, If I got this right, it's meant as a slow onset medication and the albuterol are meant as quick-fixer-uppers?

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Yep, that's a good way to put it. Inhaled steroids treat inflammation of the airways. They take several days to achieve maximal effect. They are not intended to treat sudden, immediate symptoms. Rather, they're intended to keep control of the situation (which is why they're called "control" rather than "rescue" meds).

Beta-agonists, the successors to Primatene, work by an entirely different mechanism: they relax the smooth muscle that is constricting the airways and reducing airflow.

Combining a steroid with a long-acting beta agonist into drugs like Symbicort and Advair is designed to give long-acting, daily control.

If you break through with wheezing while on one of the control agents, the shorter acting beta agonist albuterol (Proventil, Ventolin, many others -- rescue agents) is used to regain control. For a milder asthmatic, this drug alone is enough -- use it only when you have symptoms. Or, if you have exercise-induced asthma, just before exercise.

We also have other asthma meds that work by yet other mechanisms. Singulair inhibits inflammation by another mechanism than steroids (it inhibits mediators called leukotrienes). Like inhaled steroids, it takes a few days to work and should be taken every day. Atrovent is an inhaled drug that blocks mucous production and keeps the airways cleaner. It can be used acutely.

So we've got an assortment of asthma drugs that work in different ways. We've come a long way since I first started treating severe asthma 30 years ago. Our drugs then (much like OTC Primatene) were much blunter instruments, didn't work as well, and were more dangerous.

Paul said:

On the whole Singulair thingy CG, have you received any feedback re its 'groggy the next day' observation?

If you cant say, that's fine

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I've not heard that. But I treat children, who may not realize what's going on. It is often suggested that Singulair be taken at bedtime.

Since I'm an ICU doc, my experience with asthmatics is mostly in the more severe ones, the ones who often are on multiple drugs.

Primatene -- simple adrenaline/epinephrine -- can cause major side-effects, particularly in anybody who has coronary heart disease or high blood pressure. The overdoses happen because somebody is short of breath, takes some, still feels tight, takes some more, and so on.

What the beta-agonists do is to greatly reduce the so-called alpha-agonist component of epinephrine. That's the part that constricts blood vessels and increases the heart rate. Albuterol still has some effect on these things, but not nearly as much.

The whole "banning Primatene is yet another example of stupid government regulations" theme of this thread is wrong anyway. Prescription inhalers also used to have CFC as the propellant, but they changed to another agent some years ago (called HFA). I assume nothing would have prevented the makers of Primatene from doing that, although I don't know that for sure. I'm glad they chose not to, because I think Primatene is essentially an unsafe drug.

So sorry to spoil the fun.