Recommendations for Patients Who Used Primatene Mist

As of the end of 2011, the only OTC asthma inhaler was removed from shelves due to its damaging effect on the environment.

At the end of 2011 and after 50 years of availability, the only OTC asthma inhaler, Primatene Mist (epinephrine), was removed from the shelves. Pharmacists may field questions from the approximately 3 million patients who relied on Primatene Mist about what to do next. Most studies indicate that patients used Primatene Mist out of convenience rather than financial concern.

Primatene Mist was discontinued not because it was ineffective, but because its operation relied on chlorofluorocarbon (CFC) propellants, which are harmful to the environment because they deplete the ozone layer in the earth’s upper atmosphere. The United States promised to discontinue use of CFCs after signing the Montreal Protocol on Substances that Deplete the Ozone Layer. Most inhalers that once depended on CFCs now use hydrofluoroalkane instead.

"Primatene Mist does not treat asthma—it treats symptoms that can come from asthma," Kyle Hogarth, MD, an assistant professor of medicine and the medical director of the pulmonary rehabilitation program at the University of Chicago Medical Center, told the Los Angeles Times.

Pharmacists can provide the following guidance to patients:

• Do not buy Primatene Mist over the Internet because it may be mislabeled or have no effective ingredients.
• The National Asthma Guidelines from the National Institutes of Health recommend against using Primatene Mist.
• As a “rescue” medication, Primatene Mist treats only asthma’s symptoms.
• Treating symptoms alone allows repeated asthma attacks that can permanently damage lungs.
• Rescue medications should only be used once or twice a week.
• Many prescription-only products are available and provide better options for asthma management because they actually help prevent attacks.
• Prescription inhalers need to be cleaned and primed differently from Primatene Mist.
• Patients who used Primatene Mist because they were uninsured or underinsured may be able to access patient assistance programs such as the Partnership for Prescription Assistance (www.pparx.org) or RxHope (www.rxhope.com).
• Federally funded health centers, where patients pay to see a doctor based on their income and what they can afford, may be another option. See this website or call (888) 275-4772 to learn more.
• Having a written action plan that covers preventive strategies, such as dealing with seasonal allergies and other asthma triggers and guidelines for what to do if symptoms flare, can help improve asthma significantly.

Combivent Inhalation Aerosol (albuterol and ipratropium in combination) and Maxair Autohaler (pirbuterol) are the last 2 inhalers containing CFCs. They may be sold until December 31, 2013.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.