Inhalers are the cornerstone of asthma symptom treatment. Most people with asthma will attest that they take these little devices everywhere they go, as – depending on the type of inhaler – they not only prevent asthma attacks but can help ease breathing problems as they occur. They play a vital role in managing asthma and chronic obstructive pulmonary disorders (COPD). As we’ve detailed, inhalers are also expensive. The rising cost of prescription inhalers has left many patients looking for lower-cost over-the-counter (OTC) options to help relieve their symptoms. But, do these non-prescription drugs work?

We took a deep dive into OTC inhaler options to help you determine what is best for you and your condition. You should always consult a health care provider before you start any treatment plan.

Types of over-the-counter inhalers

Albuterol, the drug that is most commonly contained in most prescription inhalers, is only available via a written prescription from a licensed health care provider. You cannot buy albuterol over the counter.

There are currently only two inhalers that have been approved by the Food and Drug Administration (FDA) for purchase over the counter. The FDA has issued a warning about these products due to multiple instances of adverse reactions. Neither of these drugs will prevent asthma attacks, nor should they be used as long-term treatment options for asthma. Patients with asthma should ensure that they have ready access to prescription asthma medication such as albuterol and levalbuterol.

Primatene Mist is an FDA-approved metered dose inhaler used to provide temporary relief for mild asthma symptoms. This includes shortness of breath, chest tightness, wheezing, and coughing. Primatene Mist contains the active ingredient epinephrine–also known as adrenaline. Epinephrine acts on airways, causing them to widen. This makes it easier for air to flow back and forth from the lungs.

Primatene Mist was temporarily taken off store shelves in 2011 due to its use of propellant chlorofluorocarbons (CFCS). These chemicals were found to be harmful to the ozone layer. Primatene Mist was reformulated with a new propellant called hydrofluoroalkane (HFA) to project the epinephrine inhalation aerosol medication.

Primatene Mist comes with 160 metered doses. These are counted on a built-in meter every time you use the inhaler. As a quick-relief treatment for mild asthma symptoms, patients should inhale 1 to 2 doses of Primatene Mist but should not exceed 8 inhalations in a 24-hour period.

This OTC asthma inhaler is not FDA-approved for long-term use or for the treatment of severe asthma. It should also not be used as a treatment for other breathing-related health conditions such as chronic obstructive pulmonary disorder.

Asthmanefrin is an asthma medication available OTC. This means that you can purchase it in most pharmacies or drug stores. Asthmanefrin contains the drug racepinephrine, which works very similarly to epinephrine. A bronchodilator, racepinephrine widens the airways to and from the lungs, making it easier to breathe. This reduces wheezing, shortness of breath, and other mild symptoms caused by asthma.

Asthmanefrin is sold in liquid form to be used with a nebulizer. A nebulizer machine will turn the liquid medication into a fine mist, which is inhaled through a mask attachment.

Asthmanefrin should be inhaled one to three times every three hours to help reduce mild asthma symptoms. Because it must be inhaled through a nebulizer, this medication is less portable than Primatene Mist but works very similarly. Asthmanefrin should not be used for long-term asthma treatment or severe asthma.

NOTE: The medications listed above contain the drug epinephrine. The FDA has issued a warning about multiple adverse reactions to these products. Symptoms of these events include chest pain, nausea and vomiting, increased blood pressure, and more. These OTC drugs carry a greater risk of adverse reactions than prescription medications such as albuterol and levalbuterol. Patients with asthma should not replace prescription asthma medication with OTC asthma medication. OTC asthma drugs are less effective and more likely to cause potentially serious adverse reactions than prescription medications.

Side Effects

OTC inhalers have been shown to cause side effects. You should talk to your health care provider before starting any sort of treatment plan with OTC medication. This is because drugs may interact with previous health conditions or other medication you are currently taking causing potentially life-threatening adverse reactions.

Talk to your health care provider if these side effects become severe or do not go away after a few days.

Common side effects include:

• Elevated heart rate
  
• Elevated blood pressure
  
• Chest pain
  
• Dizziness
  
• Sinus pain
  
• Sore throat
  
• Hyperactivity/ nervousness
  
• Trouble sleeping
  
• Nausea and vomiting
  
• Stomach ache
  
• Loss of appetite
  
  

Again, you should inform your health care provider right away if the symptoms listed above become severe or persist for more than a few days. If you experience side effects such as severe shortness of breath, a rapid heart rate, hives, or chest pain you should call 911 or go to an emergency room right away.

It is important to note that OTC inhalers using epinephrine have shown multiple adverse events. Symptoms of these reactions include chest pain, nausea and vomiting, increased blood pressure, tachycardia, and hemoptysis. Patients with asthma should have ready access to inhaled rapid onset beta-2 selective agonist medications such as albuterol and levalbuterol. These are far more effective at treating asthma symptoms and carry less risk of adverse reactions.

Prescription Inhalers for Asthma

As stipulated above, OTC asthma inhalers should not be used for long-term treatment nor should they replace the use of prescription inhalers. Prescription medication is still the frontline treatment for asthma, as it has far fewer side effects and is more effective.

Quick-relief inhalers are used as needed as asthma symptoms begin to occur. Short-acting beta-2 selective agonists used for quick relief include albuterol (generic for Ventolin and Proair Respiclick) and levalbuterol (generic for Xopenex).

Long-acting inhalers control asthma by reducing inflammation and irritation in the airways. These drugs are administered every day—sometimes multiple times per day. Medication used in this category includes long-acting beta-agonists (LABA), inhaled steroids (ICS) and combination inhalers that use both.

Short-acting inhalers are generally cheaper than long-acting inhalers and ICS inhalers are generally cheaper than LABA inhalers. In most cases, patients will be prescribed both a rescue inhaler for emergencies and a daily or twice-daily, long-acting inhaler for overall maintenance.

You don’t need to go all the way to a doctor’s office to get a prescription for one of these inhalers. Telehealth platforms like Sesame make it easier than ever to talk to a licensed health care provider and get comprehensive treatment right away. Sesame offers both video prescription and prescription refill visits and telehealth asthma visits with primary care physicians. These convenient and affordable appointments allow you to discuss your condition with a highly-experienced health care provider from the comfort of your home. Providers can prescribe asthma medications during these video visits, if appropriate. Depending on the medication, you can have your prescription delivered to your home or ready for same-day pickup at a pharmacy of your choice.

For more information about asthma inhaler costs (and how to cut them) check out our Asthma Inhaler Cost Comparison article here.