People with asthma should discuss the pros and cons of over-the-counter epinephrine inhalers with their doctor.
Asthma is a disease in which there is a brief, temporary narrowing of the airways in the lungs, referred to as bronchospasm. This is only part of the picture. The main problem in asthma involves inflammation and swelling of the airways. It is important to understand that the lungs have a series of tubes akin to branches of tree leading to each of the air sacs of the lungs. When these tubes become inflamed, the walls thicken and the opening of the tube narrows. This causes increased resistance for air flow. In addition, these changes make it easier for bronchospasm to occur. Both bronchospasm and thickened airway walls prevent air from moving in and out of the lungs easily. As a result, a patient with asthma has episodic difficulty breathing. An asthmatic episode can resolve spontaneously or may require treatment.
It is crucial to understand that over time the airway inflammation associated with asthma can result in permanent remodeling/scarring of the airways. When this occurs and lung function no longer returns normal when not having an attack, Asthma moves into the category of disease known as chronic obstructive pulmonary disease (COPD). Therefore, if persistent symptoms of chest tightness, cough, wheezing, shortness of breath occur, it is imperative to be evaluated by a physician. Even mild symptoms, if long lasting, can reflect chronic inflammation and progress to COPD. The available over-the-counter (OTC) medications treat bronchospasm primarily and have little, if any, effect on airway inflammation. It is not advisable to use over-the-counter asthma medication unless instructed by a physician knowledgeable in the treatment of asthma. Airway inflammation is treated by prescription medications such as montelukast (Singulair), zafirlukast (Accolate), and inhaled corticosteroids (steroids).
Asthmatic patients and their physicians may select from a wide variety of prescription medications. This is not true for OTC medicines, which are limited to epinephrine (adrenaline) and ephedrine. In addition, many asthmatic patients should not use epinephrine or ephedrine because of their relatively weak effectiveness or side effects.
To decide whether an OTC epinephrine or ephedrine product may be useful, patients should understand:
- the abnormal conditions that exist in the airways of asthmatics;
- the effects of epinephrine and ephedrine;
- the specific factors that should be considered when choosing and using epinephrine and ephedrine; and
- the side effects of these drugs.
The advantages of using OTC medications for asthma include their affordability and accessibility (lack of need for a prescription and/or health insurance approval). Unfortunately, these medications are less effective at controlling asthma and sometimes can be more dangerous.
Recently, the FDA published safety concerns about the new medication Asthmanefrin and the EZ Breathe atomizer. They report complications such as chest pain, nausea and vomiting, increased blood pressure, increased heart rate, and coughing up blood. Even more disconcerting, they have reports of a choking hazard from a washer dislodged during atomizer use.
Most pulmonary and allergy specialists would discourage the use of these OTC medications unless asthma symptoms are extremely mild and infrequent.