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Wednesday, March 8, 2006

Primatene Mist or Albuterol?

I’ve always been told that Primatene Mist — an over-the counter (OTC) epinephrine (adrenaline) metered-dose inhaler (MDI) — was less effective and more dangerous than Albuterol as an asthma rescue inhaler. However, a new multi-center study [Hendeles L] funded by the National Institutes of Health proves that I was wrong (at least for young adults with asthma).

For nighttime asthma attacks, lung function and symptoms improved just as fast, improved the same average amount, and the improvement lasted just as long after patients took several puffs of Primatene Mist as when they took several puffs of albuterol on a different night. Unexpectedly, average pulse rates went down after Primatene Mist, but up after albuterol. Blood potassium levels fell lower after albuterol than after Primatene Mist, further evidence that the adrenaline inhalers were safer than the albuterol inhalers. Similar studies have not been done in children or older adults, but should be.

If you have mild asthma and have run out of your prescription albuterol and can’t afford to see a doctor for a new prescription, then now may be the time to buy a few canisters of Primatene Mist or generic epinephrine inhalers, because an FDA committee voted 11 to 7 a couple of months ago to recommend that it be taken off the market. About 5 million were sold last year for about 12 dollars each.

Note that there was also a recent shortage of albuterol (Proventil, Ventolin, or generic 6 dollar) inhalers, which may again occur because the FDA has announced that traditional MDIs which use CFC propellants must no longer be sold in the United States after December 2008, so apparently companies are reducing their inventories.

I think that the rationale, “CFCs reduce the ozone layer” is ridiculous because the total effect of medicinal inhalers on ozone is probably one millionth of that due to military and industrial activities.

I am concerned that somebody is planning to “put the squeeze” on folks with asthma during the next couple of years by forcing them to get a prescription for the new HFA inhalers. This action will both reduce ready availability and cost much, much more than Primatene Mist does now.

Who will benefit? Write your congressman and local newspaper if you are one of those who will suffer. While you are at it, ask why no generic corticosteroid inhalers are available yet for poor folks with moderate to severe asthma.

Related Topics: 2-Drug Strategy May Improve Asthma, New Warnings for 3 Asthma Drugs

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Posted by: Paul Enright MD at 5:56 am


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