Over The Counter Medicine For Asthma: What You Need to Know

Approximately 1 in 13 people¹ lives with asthma in the US. Symptoms of asthma include shortness of breath, pain or tightness in the chest and coughing. 

Asthma has no cure, but there are prescribed drugs that can prevent asthma attacks. However, these can be expensive. While over-the-counter medicines are no substitute for prescribed ones, they can help alleviate mild, intermittent asthma symptoms. 

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What are over-the-counter asthma medicines?

Over-the-counter medicine refers to medicine that you can buy without a prescription. These drugs are often safe to take, provided you follow the directions indicated on the label. Pain relievers are the most common examples of over-the-counter medicines.

Most medicines for asthma require a prescription because healthcare professionals should regularly monitor persons with asthma. While over-the-counter asthma medicines such as ephedrine, racepinephrine, and epinephrine are not substitutes for prescribed drugs, they are used to relieve mild asthma symptoms.

These medications do have potential side effects that can be dangerous in some cases. You should discuss the initiation of any over-the-counter medicine for asthma with your doctor prior to starting it to make sure it is safe for your particular condition.

Ephedrine

Ephedrine is typically used to temporarily relieve shortness of breath, tightness in the chest, and wheezing resulting from intermittent asthma. It is a known bronchodilator that eases breathing difficulties by relaxing the muscles in the lungs and widening airways.

You can use it with expectorants such as guaifenesin, which helps clear mucus from your airways. It is taken orally in the form of tablets, caplets, or syrup.

Ephedrine is mainly used to treat low blood pressure but is repurposed to treat asthma as well. It can thus result in a rapid heartbeat, which can be dangerous. Therefore, you should consult your doctor first to determine its suitability for your needs. 

Other side effects that can result from using the drug include:

  • Nervousness

  • Dizziness

  • Difficulties sleeping

  • Anxiety

  • Nausea

  • Tremors

Racepinephrine

Like ephedrine, racepinephrine is a bronchodilator that relaxes the muscles in the airways to ease breathing difficulties. It is usually taken through a handheld electric nebulizer, meaning that it gets to the lungs as you take slow, deep breaths. It can cause side effects similar to ephedrine.

Epinephrine

Epinephrine, another bronchodilator for the temporary relief of mild and intermittent asthma symptoms, is available over the counter in a metered-dose inhaler that administers an aerosolized dose to the lungs. Epinephrine has potentially dangerous side effects.

You should only use epinephrine if a healthcare provider has diagnosed you with mild, intermittent asthma symptoms. Consult your doctor before taking this medication to determine whether it is suitable for your case.

How do they work?

Ephedrine, racepinephrine, and epinephrine are classified as bronchodilators and thus have a similar mechanism of action, which involves relaxing muscle bands that tighten around airways. 

Relaxation of these muscles then allows the airways to open up, allowing more air into the lungs. These bronchodilators thus reduce mild asthma symptoms such as chest tightness, shortness of breath, and wheezing. However, they are not a replacement for prescribed medicine, and patients with more severe asthma symptoms should not depend on these over-the-counter options.

Over the counter asthma inhaler

Over-the-counter asthma inhalers can relieve mild, intermittent asthma if the patient follows the given directions.

Types of over the counter asthma inhalers

Primatene Mist

Primatene Mist is a brand name for a popular inhaler containing epinephrine as the main ingredient. It is advisable to take 1–2 puffs every 4 hours when needed. The inhaler relieves the intermittent symptoms within approximately 20 minutes. 

You should not exceed eight puffs in 24 hours. The inhaler is also not approved for children below 12 years.

Asthmanefrin

These inhalers contain racepinephrine as the main constituent. Asthmanefrin can relieve mild asthma symptoms in adults and children aged four years or older. 

You can take 1–3 puffs every three hours as needed, but you should not exceed 12 puffs in 24 hours. Asthmanefrin takes effect within 20 minutes.

How to use an over-the-counter asthma inhaler

Using an over-the-counter inhaler entails inhaling the aerosol by following these steps:

  1. Remove the cap.

  2. Prime the inhaler by shaking it well and spraying it into the air before use. 

  3. Place the inhaler in your mouth and inhale deeply while pressing down the top of the inhaler. 

  4. Continue breathing in for as long as you can.

  5. Exhale and wait for approximately a minute.

  6. If there is no relief, take a second puff following the steps above.

  7. Two sprays amount to 1 dose, and you should wait at least 4 hours before taking another. 

  8. Run water through the mouthpiece after use to clean it.

If it is your first time using an asthma inhaler, prime it four times before use. If it is not the first time, shake and spray once. Remember not to exceed eight inhalations in a day.

Risks of over-the-counter asthma inhalers

Just like other over-the-counter drugs, self-treating using non-prescribed inhalers is not advisable. It can exacerbate or pose a health risk to those with any of the following conditions:

  • Heart disease or irregular heartbeat

  • High blood pressure

  • Seizures

  • Thyroid disease

  • Diabetes

  • Glaucoma

  • Allergic reactions to racepinephrine or epinephrine

  • Prostate issues

  • Pheochromocytoma

It is thus advisable to consult a medical professional if you have any of the above conditions or are pregnant, trying to get pregnant, breastfeeding, or taking medication for depression or a psychiatric illness.

Those taking weight control drugs should also talk to a healthcare professional before buying a non-prescribed inhaler. The inhalers may interact with the medication, and it is thus a good idea to inform the healthcare of the medicines you are currently taking.

Side effects of over the counter asthma inhalers

Side effects of asthma inhalers include:

  • Difficulties sleeping

  • Nausea or vomiting

  • Sweating profusely

  • High blood pressure, potentially severe

  • Fast heart rate, potentially severe

Managing asthma by avoiding triggers

While over-the-counter asthma inhalers can offer quick relief to mild asthma symptoms, minimizing asthma attacks by managing known triggers is advisable. 

Common triggers of asthma include the following:

Tobacco smoke

You should not smoke if you have asthma as this can trigger an attack, and so can inhaling second-hand smoke. Stay in smoke-free environments or discourage those around you to refrain from smoking or do it somewhere else.

Outdoor air pollution

Emissions from cars, factories, and even wildfire smoke can trigger asthma attacks if inhaled in large amounts. Therefore, it is best to be aware of the pollution levels by paying attention to air quality levels on the television or by checking online.

Dust mites

These microscopic bugs found in many homes can trigger attacks if you are allergic to them and have asthma. 

You can prevent attacks by maintaining relatively low humidity levels in the house, washing and drying your bedding regularly, and using an allergen-proof mattress and pillow covers to avoid contact with dust mites.

Pets

If you are allergic to furry pets and have asthma, you can reduce exposure by keeping pets away from your bedroom, bathing your pets regularly, and using air cleaners with HEPA filters to eliminate the allergen. 

Trimming your pet’s fur does not help with your asthma, though, as people with asthma are not allergic to fur but rather the allergens it might shelter.

Mold

If you have asthma, breathing in mold can trigger an attack even when you are not allergic to it. Mold grows in damp areas like the kitchen, bathroom, basement, and places with water leaks. 

Drying your kitchen, bathroom, and other moist areas can prevent mold growth. It would be best if you fix faulty plumbing to prevent water leaks and replace absorbent materials like ceiling tiles where mold is present. Also, clean surfaces where mold is present by scrubbing with detergent and water.

Disinfectants

Stay safe by avoiding places where cleaners and disinfectants are being used because they are potential triggers. Most disinfectants can trigger asthma attacks, but you can reduce the likelihood of that occurring by asking about safer products that you can use. 

Generally, avoid products with strong fragrances and bleach or cleaners with ammonium compounds, especially in enclosed spaces.

When to seek medical help for an asthma attack

You should see a doctor for an asthma attack if over-the-counter inhalers do not have the desired impact, such as when you do not improve in 20 minutes or even get worse. More than six inhalations a day should also be your cue to see a doctor. 

You should also seek medical help if your heartbeat is consistently above 100 beats per minute at rest or if you are experiencing nervousness, tremors, or seizures after using the inhalers. Also, visit a healthcare professional if you suspect an overdose.

The lowdown

Most medications for asthma are prescribed, although there are over-the-counter options to treat mild, intermittent asthma symptoms such as shortness of breath, chest tightness, and wheezing. 

These over-the-counter medicines include ephedrine, racepinephrine, and epinephrine. Ephedrine is available in tablets, caplets, and syrups, while racepinephrine and epinephrine are packaged in inhalers under the brand names Primatene Mist and Asthmanefrin, respectively. 

These over-the-counter asthma medicines act as bronchodilators that relax the muscles around the airways, easing any difficulties in breathing. While they may prove effective in relieving symptoms, they are not a substitute for asthma prescriptions. 

These over-the-counter medications can also have serious, possibly life-threatening side effects. You should always consult a healthcare professional before starting these medications, as they are contraindicated for people with certain conditions.

  1. Asthma facts and figures | Asthma and Allergy Foundation of America

Other sources:

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