Living with asthma is never easy. If it isn't the wheezing and difficulty breathing during attacks, it's the constant fear of triggering a flare-up. The good thing, however, is that various asthma medications can quickly alleviate these symptoms.
Even better, there are now various FDA-approved over-the-counter (OTC) inhalers¹ you can get for emergencies. These over-the-counter products have proven effective in handling mild asthma symptoms. They are also easy to access and generally more affordable than prescription medication.
But then again, these OTC medications are not meant for everyone. If you have been diagnosed with a more severe case of asthma, you should stick to prescription medication to keep your symptoms at bay.
Wondering if over-the-counter inhalers are for you? Here's all you need to know.
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Asthma is one of the most commonly experienced long-term lung diseases out there. Usually, when asthma patient is exposed to certain triggers, their airways get inflamed. The muscles surrounding their airways might also tighten, and excess mucus might be released.
All this makes it hard to move air in and out of your lungs.
Asthma affects over 25 million individuals in the United States² and approximately 300 million individuals worldwide³.
Some symptoms that might occur during an asthma attack include:
Shortness of breath
Wheezing when you exhale
Tightness in the chest
Patients may experience some or all of these symptoms during a flare-up or asthma attack (when the symptoms are at their worst). If not properly and quickly managed, attacks can be life-threatening, often leading to trips to the emergency room.
Being a chronic condition, asthma never completely goes away. However, if correctly managed through proper treatment and monitoring, patients can live with the condition and experience fewer symptoms and less severe attacks.
Anyone can get asthma at any age. It is not clear what exactly causes asthma and why it affects some and not others. However, the most probable causes are genetic and environmental factors.
Factors that might increase the chances of getting asthma include:
Allergies – People with allergies are generally more likely to develop asthma in their lifetime.
Environmental factors – You can develop asthma if constantly exposed to things irritating your airways. This includes toxins, fumes, and allergens to second and third-hand smoke. It is even more harmful to young children.
Genetics – When other people in your family have allergic diseases or asthma, there's a chance you might develop it as well.
Respiratory infections – Some respiratory conditions like the respiratory syncytial virus can make children vulnerable to asthma.
Most asthma attacks tend to occur after coming into contact with things in your surrounding that irritate you. These substances can be referred to as triggers. Therefore, you can prevent asthma attacks by knowing your triggers and avoiding them.
For some, triggers don't always cause immediate reactions — an attack can come hours after exposure or even days later.
According to the CDC, some common asthma triggers include:
Air pollution – This includes any pollutants in the air, such as car exhausts, factory emissions, and smoke from fires, among others.
Dust mites – These are microscopic bugs living in our homes. If you are allergic to dust mites and have asthma, exposure to them can lead to an asthma attack.
Exercise – Vigorous exercise can cause an attack in some people.
Pets – If you have pet dander allergies, inhaling the dried skin flakes from your pets can irritate the airways, leading to an attack.
Tobacco smoke – If you or the people around you smoke, it can increase the risk of asthma. It is even worse in enclosed spaces like cars or enclosed rooms. If you already have asthma, you are advised to quit smoking.
Occupational exposures – Some other triggers can be in the workplace — for example, certain cleaning products, dust in wood and flour, and some chemicals.
Besides these, there are a few other less common triggers, including cold air, respiratory infections like the common cold, stress and strong emotions, and gastroesophageal reflux, which is a condition where your stomach acids move back up to your throat.
While asthma symptoms might appear obvious, they are similar to those of many respiratory infections, making asthma hard to distinguish.
To diagnose asthma, the healthcare provider will start by reviewing your medical history. They will ask about any allergies or lung diseases you might have experienced, as well as some information about your family.
They might also ask that you do a spirometry⁴ test that measures how air flows through your lungs. Your provider might order tests including a chest x-ray and skin and blood tests. Once it is confirmed, your provider will recommend a suitable course of treatment.
There are various medications that people can use to relieve their asthma symptoms. Some of these also help reduce the severity of future attacks. You might need to blend the different treatment approaches to effectively manage your asthma.
Quick-relief treatments, such as inhalers, are mainly used when you need immediate action against asthma symptoms. They can provide instant relief or keep them from getting worse.
These are prescription medications that are taken regularly to reduce a patient's inflammation in the long term. These medicines are used regardless of whether a person is experiencing symptoms.
Part of the treatment also means actively avoiding factors that can cause flare-ups. These can be allergens or certain activities and places.
Asthma medications come in different forms. They can be oral tablets or liquids delivered through devices such as inhalers, nebulizers, or atomizers. The devices will work by spraying the medicine directly into the lungs.
Since asthma is a chronic condition, it needs regular medical supervision. For more serious asthma conditions, you might need certain prescription medications. However, there are over-the-counter treatment options available for people with mild asthma.
If you've been diagnosed with intermittent or mild asthma, some over-the-counter inhalers and other medications can be pretty effective in relieving your asthma symptoms. However, it is important that you only use these options to complement the prescribed treatment options and not as substitutes.
Some FDA-approved over-the-counter asthma treatments you can get include:
Primatene Mist HFA inhaler⁵ – The Primatene Mist inhaler is one of the most popular OTC medications for asthma. It contains epinephrine. This is an active ingredient that links with the adrenergic receptors found in your lungs. It causes the lung muscles to relax, thereby opening your airways. In turn, this makes breathing easier. Primatene can only be used by those over the age of 12.
Asthmanefrine – This is a nebulizer liquid solution containing racemic epinephrine. It has similar effects as epinephrine in Primatene Mist. The only difference here is that it can be used for children four years and older.
Oral medications such as Primatene and Bronchial Asthma Relief, among others
As it stands, Primatene Mist HFA is the only FDA-approved asthma inhaler to be sold over the counter in the United States. Some of its side effects include:
Increase in blood pressure
Nausea and vomiting
Tremor or shaking
Primatene Mist should only be used by children over 12 and adults. Also, it shouldn't be used as a substitute for prescription inhalers for asthma patients or people needing regular asthma treatment.
If you have a history of heart disease or high blood pressure, it is vital that you take the recommended dose. Otherwise, it might put you at risk of getting a heart attack.
As much as these OTC inhalers work in alleviating symptoms, they don't have the same components as the more popular prescription inhalers like albuterol. Therefore, depending on your medical history and symptoms, they might not work as effectively.
As always, you want to discuss this with your pharmacist or healthcare practitioner before trying any OTC inhaler. Furthermore, epinephrine is not selective for the beta receptors in the lungs and thus carries risks of severe side effects, especially in high doses.
Asthmanefrin⁶ is yet another OTC medication containing racemic epinephrine as its main active ingredient. You can get the inhaler without a prescription, which can help relieve mild asthma symptoms such as tightness in the chest, wheezing, and shortness of breath.
The drug can be taken by anyone over the age of four.
Some of the side effects of Asthmanefrin are:
Irregular or rapid heartbeat
If you have a history of high blood pressure, heart disease, seizures, glaucoma, diabetes, or an enlarged prostate, make sure you talk with your physician before taking Asthmanefrin. It can react with some medications, which can aggravate other health conditions.
This is an OTC tablet composed of guaifenesin and ephedrine (a sympathomimetic that opens the airways). Guaifenesin helps by thinning mucus, making it easy for asthma patients to cough out phlegm from the lungs.
Bronchial Asthma Relief can be taken by anyone above 12 years old with mild asthma symptoms.
Some of the side effects of Bronchial Asthma Relief include:
Loss of appetite
Anxiety or nervousness
Irregular heartbeat or a racing heart
Bronchial Asthma Relief is mainly recommended for the treatment of mild asthma symptoms. Don't take it for severe asthma or if you are already taking prescription medication for asthma.
Also, it might react negatively with drugs such as monoamine oxidase inhibitors (MAOIs), so discuss it with your doctor if you have any underlying heart conditions or high blood pressure.
If you've been diagnosed with severe asthma, you should avoid OTC inhalers. At the same time, if there ever was a time when you were hospitalized due to asthma symptoms, you should consult your healthcare provider before using any OTC inhalers.
If, after trying the OTC, you don't notice any positive changes, make sure to visit your healthcare provider and seek counsel.
There is no sure way of preventing asthma from developing. Depending on your condition, your doctor should be able to come up with a step-by-step plan for managing your asthma and reducing the frequency of attacks.
Some ways you can reduce the risk of asthma include:
Start by discussing this with your healthcare team. Come up with a detailed plan on how to manage your asthma attacks and how to take medication. Asthma is a long-term condition. You'll need regular treatment and monitoring to fully control your life.
Respiratory conditions often trigger asthma flare-ups. Therefore, one effective prevention tactic is getting the latest vaccinations during flu season and a COVID-19 shot.
Each person has certain triggers that can affect them more than others. By identifying yours, you can actively try and avoid them and, by doing so, prevent a future attack.
OTC inhalers can be temporary alternatives for other asthma medications. They are especially suited for providing relief for mild or infrequent asthma attacks. Of all of them, Primatene Mist and Asthmanefrin are the more popular, reputable options.
However, if you have more severe asthma symptoms, you'd best consult your healthcare provider and have them recommend a more suitable treatment option.
Remember, asthma and its symptoms tend to change over time. Therefore, it is crucial that you still have regular checkups. Before using any OTC inhalers, visit your doctor and get a proper diagnosis. Respiratory conditions share so many symptoms with each other, making it hard to tell them apart.
FDA statement on approval of OTC Primatene Mist to treat mild asthma | U.S. Food & Drug Administration
Asthma facts and figures | Asthma and Allergy Foundation of America
CDER conversation: Safely using the newly available OTC asthma inhaler Primatene mist | U.S. Food & Drug Administration
Assess and monitor your asthma control | American Lung Foundation
Common asthma triggers | Centers for Disease Control and Prevention (CDC)