Over the counter asthma inhalers
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Over-the-Counter Asthma Inhalers: Safety, Effectiveness, and Risks
OTC Asthma Inhalers for Mild, Intermittent Asthma
Over-the-counter (OTC) asthma inhalers, such as epinephrine-based products like Primatene Mist, are intended for people with mild, intermittent asthma and can be safe and effective when used as directed for occasional relief of symptoms in this group129. These inhalers are approved for use in individuals aged 12 and older29. However, guidelines emphasize that people with persistent or more severe asthma should be under a physician’s care and use prescription medications, such as inhaled corticosteroids, rather than relying on OTC inhalers19.
Risks of Misuse and Overuse of OTC Inhalers
Misuse or overuse of OTC asthma inhalers can lead to serious health risks, including severe adverse reactions and even death1379. Studies show that a significant number of people who use OTC inhalers have persistent asthma, which puts them at higher risk if they are not receiving appropriate prescription therapy17. Overuse of short-acting beta-agonists (SABA), which are commonly available OTC, is linked to poor asthma control, more frequent asthma attacks, increased emergency room visits, and higher risk of death357. Many patients do not fully understand these risks, and lack of education about proper asthma management contributes to the problem78.
Patterns of OTC Inhaler Use and Asthma Outcomes
Research from various regions, including the United States, Australia, and Saudi Arabia, shows that a notable proportion of asthma patients obtain and use inhalers without a prescription357. In some studies, up to 39.6% of asthma patients reported purchasing SABA inhalers OTC, and among these, a large percentage overused them. Overuse is especially common among those with moderate to severe asthma and those who do not use preventive medications. Patients who overuse OTC inhalers experience more severe asthma exacerbations and poorer asthma control compared to those who use them appropriately or have prescriptions357.
Cost-Effectiveness and Alternatives to OTC Epinephrine Inhalers
Recent analyses suggest that if as-needed budesonide-formoterol (a combination inhaled corticosteroid and long-acting beta-agonist) were made available OTC, it would be more cost-effective, improve asthma outcomes, and reduce asthma-related deaths compared to OTC epinephrine inhalers. This supports the idea that better alternatives to current OTC options could benefit underinsured or underserved populations with mild asthma.
Concerns from Healthcare Professionals and Policy Implications
Healthcare professionals and organizations have raised concerns that making asthma inhalers available OTC could undermine asthma management guidelines, lead to increased healthcare costs, and worsen asthma control at the population level910. Community pharmacists and physicians worry about patients’ reliance on quick-relief inhalers and the lack of regular follow-up and education810. Improved patient education, regular monitoring, and clear labeling are recommended to help prevent misuse and ensure safe use of OTC inhalers178.
Conclusion
OTC asthma inhalers can provide quick relief for mild, intermittent asthma when used correctly, but their misuse and overuse are linked to poor asthma outcomes and increased health risks13579. Most experts and guidelines recommend that people with persistent or severe asthma should not rely on OTC inhalers and should instead seek regular medical care and use prescription medications. Better education, monitoring, and possibly safer OTC alternatives are needed to improve asthma management and patient safety47810.
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