Over-the-counter asthma inhalers
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Safety and Effectiveness of Over-the-Counter Asthma Inhalers
Over-the-counter (OTC) asthma inhalers, such as epinephrine and short-acting beta-2 agonists (SABA), are available in several countries for the relief of mild, intermittent asthma symptoms. When used as directed by individuals with mild, intermittent asthma, these inhalers can be safe and effective for occasional use. However, misuse or overuse can lead to severe adverse reactions, including death, especially in those with more persistent or severe asthma who should be under medical supervision and using corticosteroid therapy instead 129.
Risks of Overuse and Poor Asthma Control
Multiple studies have shown that the availability of OTC inhalers is linked to overuse, undertreatment, and poor asthma control. Overuse of SABA inhalers is associated with increased risk of asthma attacks, more frequent emergency room visits, and even higher rates of asthma-related deaths 4567. Many patients who purchase inhalers OTC do not consult healthcare professionals regularly, leading to inadequate management of their asthma and a lack of education about proper inhaler use and the risks of overuse 5678.
Patterns of OTC Inhaler Use
The prevalence of OTC SABA use varies widely, with studies reporting that between 1.4% and 39.6% of asthma patients use these medications without a prescription. Among OTC users, 14% to 66.4% are considered over-users, often relying on these inhalers for quick relief rather than addressing underlying inflammation with preventer medications like inhaled corticosteroids . Factors contributing to OTC overuse include moderate-to-severe asthma, lack of understanding about the risks, and barriers to accessing regular medical care 78.
Cost-Effectiveness and Alternatives
Recent research suggests 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 and safer than OTC epinephrine inhalers. This alternative would improve asthma outcomes, reduce severe exacerbations, and prevent fatalities, especially among underinsured adults who may not have regular access to healthcare providers .
Concerns from Healthcare Professionals
Healthcare professionals and organizations have raised concerns that making asthma inhalers available OTC conflicts with current asthma management guidelines, which emphasize the importance of regular monitoring and the use of inhaled corticosteroids for persistent asthma. There is also concern that OTC availability could increase overall healthcare costs due to worsening asthma control and more frequent hospital visits 1910.
The Role of Education and Monitoring
Improving patient education about asthma, the risks of SABA overuse, and the importance of regular follow-up with healthcare providers is essential to prevent the negative consequences associated with OTC inhaler use. Community pharmacists and healthcare professionals play a key role in assessing inhaler use, providing education, and encouraging appropriate asthma management 78.
Conclusion
While OTC asthma inhalers can provide quick relief for mild, intermittent asthma, their widespread availability and potential for misuse pose significant risks. Overuse is linked to poor asthma control, increased exacerbations, and higher healthcare utilization. Ensuring that patients receive proper education, regular monitoring, and access to safer, more effective treatments is crucial for improving asthma outcomes and reducing the risks associated with OTC inhaler use.
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