Over-the-counter (OTC) inhalers are not approved for treatingchronic obstructive pulmonary disease(COPD). Aside from the fact that they are ineffective for COPD, these inhalers can pose risks including masking symptoms and increasing treatment side effects.
This article discusses OTC inhalers and why they are not recommended for people with COPD.
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OTC vs. Prescription Inhalers
There are no OTC medications approved for the treatment of COPD. The condition is managed with a combination of short-acting bronchodilators likealbuterolfor acute symptoms and long-acting maintenance medications to prevent exacerbations.
Short-acting bronchodilators are used as a rescue inhaler to treat acuteCOPD symptomsofdyspnea(shortness of breath), chest tightness,wheezing, and coughing spells.
Prescription rescue inhalers deliver a class of drugs known asshort-acting beta 2-agonists(SABAs). The OTC inhalerPrimatene Mist(epinephrine inhalation aerosol) is also a short-acting bronchodilator. It containsepinephrine, the drug form of the hormone adrenaline that is commonly used to treat allergic reactions.
Epinephrine is not recommended as a substitute for prescription SABAs, which are the gold standard for treating acute COPD exacerbations.These include:
In 2011, Primatene Mist was pulled from the market due to its use of chlorofluorocarbons (CFCs) as a propellant, which was banned for environmental reasons. After reformulating to use hydrofluoroalkanes (HFAs) instead, Primatene Mist returned to drugstore shelves in 2018.
Risks and Concerns
Using an over-the-counter breathing treatment for COPD raises the following concerns. You should not use one without first consulting with your healthcare provider.
Ineffective For COPD
While SABAs and Primatene Mist are short-acting bronchodilators, they are not equal.
SABAs bind to the beta 2-adrenergic receptor, signaling the smooth muscle tissue of the lungs to relax and dilate the bronchi andbronchioles, relievingbronchospasmsthat cause chest tightness and coughing.
Epinephrine, an alpha- and beta-adrenergic agonist, works similarly to SABAs to make breathing easier, but not as well.Epinephrine may be helpful for treating an asthma attack, but it does not appear to be effective during aCOPD flareup.
Masks Worsening COPD
Short-acting bronchodilators are the first-line inhalers for COPD, but may not be enough to control symptoms long-term as the disease progresses. Most people with COPD also need to use long-acting controller medications to prevent symptoms and dangerous flare-ups.
Using an OTC inhaler may mask a worsening of your condition and delay you in getting appropriate medical care.
Prevent Better COPD Control
COPD exacerbations are serious and often require hospitalization. Instead of adding an OTC medication on your own, which is unlikely to be effective and may be dangerous, ask your healthcare provider for an action plan for managing flare-ups. Tell your healthcare provider anytime you experience an exacerbation.
If you are unable to manage your COPD on prescription rescue inhalers alone, your healthcare provider will likely prescribe one of the following for long-term symptom management and prevention of exacerbations:
Increased Side Effects
Taking OTC epinephrine alongside other short-acting bronchodilators may cause unpleasant side effects. Though not contraindicated for combined use, both epinephrine and albuterol-type medications can increase your heart rate and cause nervousness and tremors.Combining medicationscan increase this effect.
If you continue to have difficulty breathing or experience chest pain, seek immediate medical help.
Guide to Over-the-Counter Inhalers for Asthma
Non-Drug Ways to Improve COPD Management
If you have COPD and are reaching for an OTC inhaler because you are struggling to manage symptoms there are a few non-drug ways to improve your condition in addition to using your medications as prescribed.
How Chronic Obstructive Pulmonary Disease (COPD) Is Treated
If You Can’t Afford Your Prescriptions
The high cost of prescription medications can lead some people with COPD to substitute with OTC inhalers. If you are struggling to pay for the medications your healthcare provider prescribed, there are a few things you can do.
If you haveprescription drug insurance, call to find out the preferred medications for treating COPD. These will typically have a reduced copay compared to medications in a higher tier on theprescription drug formulary.
Your healthcare provider may be able to switch you to a similar medication with a lower out-of-pocket cost to you.
In addition, the patents on several COPD medications have expired in recent years, opening the market to lower-priced generic drugs that your healthcare provider can prescribe instead. These include:
Many pharmacies and drug companies also offer coupons that can save you money on your medications with prescription discount cards. The following COPD drug manufactures offer programs that can help offset the cost of treatment:
Prescription Assistance Programs for Asthma Medications
Summary
OTC inhalers can help treat mild asthma symptoms, but they do not treat COPD. These inhalers contain different ingredients and have not been shown to help relieve COPD symptoms. They may also prevent some people from seeking the advice of a healthcare provider for managing COPD.
You can help reduce your COPD symptoms in other ways, such as changing your diet, losing weight, and avoiding triggers. If you can’t afford your medication, talk to your health insurance company or pharmacist to see if discounts or generic drugs are available.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nici L, Mammen MJ, Charbek E, et al.Pharmacologic management of chronic obstructive pulmonary disease. an official American Thoracic Society Clinical Practice guideline.Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625STU.S. National Library of Medicine: MedlinePlus.Epinephrine oral inhalation.Food & Drug Administration.FDA statement on approval of OTC Primatene Mist to treat mild asthma.U.S. National Library of Medicine: DailyMed.Primatene Mist.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64American Academy of Allergy, Asthma, and Immunology.Why Primatene Mist may not be the best medicine.Global Initiatve of Obstructive Lung Disease (GOLD).Pocket guide to COPD diagnosis, management, and prevention—2020 Edition.Varraso R, Camargo CA Jr.Processed meat consumption and lung health: more evidence for harm.Eur Respir J. 2014;43(4):943-946. doi:10.1183/09031936.00228213
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nici L, Mammen MJ, Charbek E, et al.Pharmacologic management of chronic obstructive pulmonary disease. an official American Thoracic Society Clinical Practice guideline.Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625STU.S. National Library of Medicine: MedlinePlus.Epinephrine oral inhalation.Food & Drug Administration.FDA statement on approval of OTC Primatene Mist to treat mild asthma.U.S. National Library of Medicine: DailyMed.Primatene Mist.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64American Academy of Allergy, Asthma, and Immunology.Why Primatene Mist may not be the best medicine.Global Initiatve of Obstructive Lung Disease (GOLD).Pocket guide to COPD diagnosis, management, and prevention—2020 Edition.Varraso R, Camargo CA Jr.Processed meat consumption and lung health: more evidence for harm.Eur Respir J. 2014;43(4):943-946. doi:10.1183/09031936.00228213
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Nici L, Mammen MJ, Charbek E, et al.Pharmacologic management of chronic obstructive pulmonary disease. an official American Thoracic Society Clinical Practice guideline.Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625STU.S. National Library of Medicine: MedlinePlus.Epinephrine oral inhalation.Food & Drug Administration.FDA statement on approval of OTC Primatene Mist to treat mild asthma.U.S. National Library of Medicine: DailyMed.Primatene Mist.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64American Academy of Allergy, Asthma, and Immunology.Why Primatene Mist may not be the best medicine.Global Initiatve of Obstructive Lung Disease (GOLD).Pocket guide to COPD diagnosis, management, and prevention—2020 Edition.Varraso R, Camargo CA Jr.Processed meat consumption and lung health: more evidence for harm.Eur Respir J. 2014;43(4):943-946. doi:10.1183/09031936.00228213
Nici L, Mammen MJ, Charbek E, et al.Pharmacologic management of chronic obstructive pulmonary disease. an official American Thoracic Society Clinical Practice guideline.Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625ST
U.S. National Library of Medicine: MedlinePlus.Epinephrine oral inhalation.
Food & Drug Administration.FDA statement on approval of OTC Primatene Mist to treat mild asthma.
U.S. National Library of Medicine: DailyMed.Primatene Mist.
Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64
American Academy of Allergy, Asthma, and Immunology.Why Primatene Mist may not be the best medicine.
Global Initiatve of Obstructive Lung Disease (GOLD).Pocket guide to COPD diagnosis, management, and prevention—2020 Edition.
Varraso R, Camargo CA Jr.Processed meat consumption and lung health: more evidence for harm.Eur Respir J. 2014;43(4):943-946. doi:10.1183/09031936.00228213
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