Table of ContentsView AllTable of ContentsTypesBenefitsSide EffectsRisksConflicting OpinionsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Types
Benefits
Side Effects
Risks
Conflicting Opinions
Frequently Asked Questions
Over-the-counter (OTC)asthma inhalerscan help treat—but not prevent—acuteasthma attacks. While not commonly recommended for the treatment of asthma, some people still turn to them because of their convenience and price point.
These inhalers can have benefits, but there are also risks—and they are not right for everyone. This article explores the pros and cons of these medications. It also wades into the controversy surrounding Primatene Mist and Asthamanefrin and what leading health experts say about the use of over-the-counter asthma inhalers.
How Asthma Is Treated
Types of Over-the-Counter Inhalers
The two over-the-counter asthma inhalers currently sold in American drugstores—Primatene Mist and Asthmanefrin—are similar to each other and can provide temporary relief ofasthma symptoms.
Primatene Mist
Primatene Mist is an over-the-counter asthma inhaler used for the relief of acuteasthma symptoms. It contains a drug calledepinephrine(adrenaline) that acts on the airways, causing them to dilate (widen).Epinephrine is the same drug used inEpiPen auto-injectorsthat are used to treat severe allergic reactions.
Recommended DosePrimatene Mist is approved for adults and children 12 and over. The recommended dose is 1 to 2 inhalations, not to exceed 8 inhalations within a 24-hour period.
Recommended Dose
Primatene Mist is approved for adults and children 12 and over. The recommended dose is 1 to 2 inhalations, not to exceed 8 inhalations within a 24-hour period.
Primatene Mist is not intended for long-term use. Moreover, the FDA strongly recommends not using Primatene Mist unless you’ve been diagnosed with asthma. That’s because other conditions can cause asthma-like symptoms but need to be treated differently.
Asthma Inhalers: Choosing the Right Inhaler for Your Symptoms
Asthmanefrin
Asthmanefrin is a CFC-free inhaler that works similarly to Primatene Mist. It contains a drug called racepinephrine that has a similar action to epinephrine but tends to be potent.
Asthmanefrin was introduced as a cost-effectivebronchodilatorin 2012, after the discontinuation of Primatene Mist.
Asthmanefrin is not delivered in a pressurized canister like Primatene Mist. Instead, it is sold in liquid form in a 30-count pack for use in aportable nebulizer machine. This is a device that turns liquid into a fine mist for inhalation.
This makes Asthmanefrin somewhat less convenient during an asthma attack than an HFA propellant like Primatene Mist.
Recommended DoseAsthmanefrin is approved for use in adults and children 4 and over. The recommended dose is one to three inhalations every three hours, not to exceed 24 inhalations during a 24-hour period.
Asthmanefrin is approved for use in adults and children 4 and over. The recommended dose is one to three inhalations every three hours, not to exceed 24 inhalations during a 24-hour period.
Over-the-counter inhalers like Primatene Mist and Asthmanefrin have certain benefits. To many people who use them, the first is cost.
Primatene Mist currently retails for around $35 a canister. A 30-count box of Asthmanefrin retails for about the same price.
The cost of prescription inhalers varies significantly, depending on the type of inhaler. Rescue inhalers with generic drugs may cost about the same as over-the-counter inhalers. Meanwhile, brand-name rescue inhalers like Proventil (albuterol) and Xopenex (levalbuterol) are about twice as much.
Then you have maintenance inhalers, which are used regularly to prevent asthma attacks from happening. Some of them cost $300 or more.
You also save money with over-the-counter inhalers because you don’t need to see a healthcare provider to get a prescription. While that saves the cost of an office visit or co-pay, it may not be the best way to treat your asthma.
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Side Effects of Over-the-Counter Inhalers
Just like prescription medications, Primatene Mistand Asthmanefrincarry a risk ofside effects.
Primatene MistBad tasteCoughDizzinessDry mouthHeadacheNauseaNervousnessSore throatStomach acheSweatingTremorsTrouble sleepingVomitingAsthmanefrinAppetite changesDizzinessHeadacheHyperactivity (particularly in children)NauseaNervousnessSinus painSore throatSweatingTremorsTrouble sleepingVomiting
Primatene MistBad tasteCoughDizzinessDry mouthHeadacheNauseaNervousnessSore throatStomach acheSweatingTremorsTrouble sleepingVomiting
Bad taste
Cough
Dizziness
Dry mouth
Headache
Nausea
Nervousness
Sore throat
Stomach ache
Sweating
Tremors
Trouble sleeping
Vomiting
AsthmanefrinAppetite changesDizzinessHeadacheHyperactivity (particularly in children)NauseaNervousnessSinus painSore throatSweatingTremorsTrouble sleepingVomiting
Appetite changes
Hyperactivity (particularly in children)
Sinus pain
Risks of Using an OTC Inhaler for Asthma
Self-treating any medical condition poses significant risks, including:
With over-the-counter inhalers, there’s another real concern: They can become less effective over time, but you may not realize that and keep relying on them in a crisis situation.
If this happens and you experience frequent attacks, your lungs can begin to change and become stiffer and stiffer as scar tissues develop. Over time, this can reduce your lung capacity, leaving you weak and breathless with even moderate activity.
When Rescue Inhalers Are Not EnoughIf you use a rescue inhaler two or more times per week or more than two nights per month, you need to talk to a healthcare provider about startingasthma controller medications.These are inhaled, oral, or injectable drugs used regularly (sometimes daily) to help control asthma symptoms.
When Rescue Inhalers Are Not Enough
If you use a rescue inhaler two or more times per week or more than two nights per month, you need to talk to a healthcare provider about startingasthma controller medications.These are inhaled, oral, or injectable drugs used regularly (sometimes daily) to help control asthma symptoms.
According to a 2017 study published inBMJ Open,people who use over-the-counter rescue inhalers are no more likely to have uncontrolled asthma than those who use prescription rescue inhalers. However, they are 70% more likely to require urgent asthma care within a year.
What to Know About Combination Asthma Inhalers
Many health professionals do not agree.
In fact, the American College of Asthma, Allergy & Immunology, the American Association for Respiratory Care, the American Thoracic Society, and the National Association for Medical Direction of Respiratory Care do not believe that over-the-counter inhalers of any sort are safe for the treatment of asthma.
For its part, the National Institutes of Health do not include either Primatene Mist or Asthmanefrin in itsGuidelines for the Diagnosis and Management of Asthma.
Summary
There are two over-the-counter inhalers available for the treatment of asthma in the United States. They are Primatene Mist, which contains epinephrine, and Asthmanefrin, which contains a similar drug called racepinephrine.
A Word From Verywell
It is important to remember that over-the-counter inhalers do not have the same proven benefits as prescription inhalers. Moreover, in the end, they may not necessarily cost less than generic inhalers like albuterol or levalbuterol.
To make an informed judgment, speak with your healthcare provider first.
While there are no serious safety concerns with the drugs themselves, over-the-counter (OTC) inhalers may provide inadequate control of asthma symptoms. A 2017 study reported people using OTC inhalers are 70% more likely to require urgent asthma care than those using prescription inhalers.
Cost is a major draw of over-the-counter inhalers like Primatene Mist and Asthmanefrin, both of which cost around $35. The savings isn’t what it used to be, though. You can now get prescriptions for generic albuterol inhalers for about the same cost, and they’re the preferred treatment for asthma attacks.
Learn MoreWhat to Know About Albuterol Inhalers
No. Likewise, over-the-counter inhalers are not indicated for allergies, bronchitis, or non-asthma coughs.
10 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.U.S. Food & Drug Administration.FDA statement on approval of OTC Primatene Mist to treat mild asthma.American Academy of Allergy, Asthma & Immunology.Asthma treatment & management.National Institutes of Health, U.S. National Library of Medicine: DailyMed.Primatene Mist - epinephrine inhalation aerosol.Sicherer SH, Simons FER.Epinephrine for first-aid management of anaphylaxis.Pediatrics.2017;139(3):4006. doi:10.1542/peds.2016-4006Mondal P, Kandala B, Ahrens R, Chesrown SE, Hendeles L.Nonprescription racemic epinephrine for asthma.J Allergy Clin Immunol Pract.2014;2(5):575-8. doi:10.1016/j.jaip.2014.02.014DailyMed.Asthmanefrin - racepinephrine hydrochloride solution.Royce SG, Cheng V, Samuel CS, Tang MLK.The regulation of fibrosis in airway remodeling in asthma.Mol Cell Endocrinol.2012 Apr 4;351(2):167-75. doi:10.1016/j.mce.2012.01.007American Lung Society.Assess and monitor your asthma control.Reddel HK, Ampon RD, Sawyer SM, Peters MJ.Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey.BMJ Open.2017;7(9):e016688. doi:10.1136/bmjopen-2017-016688National Institutes of Health, National Heart, Lung, and Blood Institute.Guidelines for the diagnosis and management of asthma 2007 (EPR-3).
10 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.U.S. Food & Drug Administration.FDA statement on approval of OTC Primatene Mist to treat mild asthma.American Academy of Allergy, Asthma & Immunology.Asthma treatment & management.National Institutes of Health, U.S. National Library of Medicine: DailyMed.Primatene Mist - epinephrine inhalation aerosol.Sicherer SH, Simons FER.Epinephrine for first-aid management of anaphylaxis.Pediatrics.2017;139(3):4006. doi:10.1542/peds.2016-4006Mondal P, Kandala B, Ahrens R, Chesrown SE, Hendeles L.Nonprescription racemic epinephrine for asthma.J Allergy Clin Immunol Pract.2014;2(5):575-8. doi:10.1016/j.jaip.2014.02.014DailyMed.Asthmanefrin - racepinephrine hydrochloride solution.Royce SG, Cheng V, Samuel CS, Tang MLK.The regulation of fibrosis in airway remodeling in asthma.Mol Cell Endocrinol.2012 Apr 4;351(2):167-75. doi:10.1016/j.mce.2012.01.007American Lung Society.Assess and monitor your asthma control.Reddel HK, Ampon RD, Sawyer SM, Peters MJ.Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey.BMJ Open.2017;7(9):e016688. doi:10.1136/bmjopen-2017-016688National Institutes of Health, National Heart, Lung, and Blood Institute.Guidelines for the diagnosis and management of asthma 2007 (EPR-3).
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.
U.S. Food & Drug Administration.FDA statement on approval of OTC Primatene Mist to treat mild asthma.American Academy of Allergy, Asthma & Immunology.Asthma treatment & management.National Institutes of Health, U.S. National Library of Medicine: DailyMed.Primatene Mist - epinephrine inhalation aerosol.Sicherer SH, Simons FER.Epinephrine for first-aid management of anaphylaxis.Pediatrics.2017;139(3):4006. doi:10.1542/peds.2016-4006Mondal P, Kandala B, Ahrens R, Chesrown SE, Hendeles L.Nonprescription racemic epinephrine for asthma.J Allergy Clin Immunol Pract.2014;2(5):575-8. doi:10.1016/j.jaip.2014.02.014DailyMed.Asthmanefrin - racepinephrine hydrochloride solution.Royce SG, Cheng V, Samuel CS, Tang MLK.The regulation of fibrosis in airway remodeling in asthma.Mol Cell Endocrinol.2012 Apr 4;351(2):167-75. doi:10.1016/j.mce.2012.01.007American Lung Society.Assess and monitor your asthma control.Reddel HK, Ampon RD, Sawyer SM, Peters MJ.Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey.BMJ Open.2017;7(9):e016688. doi:10.1136/bmjopen-2017-016688National Institutes of Health, National Heart, Lung, and Blood Institute.Guidelines for the diagnosis and management of asthma 2007 (EPR-3).
U.S. Food & Drug Administration.FDA statement on approval of OTC Primatene Mist to treat mild asthma.
American Academy of Allergy, Asthma & Immunology.Asthma treatment & management.
National Institutes of Health, U.S. National Library of Medicine: DailyMed.Primatene Mist - epinephrine inhalation aerosol.
Sicherer SH, Simons FER.Epinephrine for first-aid management of anaphylaxis.Pediatrics.2017;139(3):4006. doi:10.1542/peds.2016-4006
Mondal P, Kandala B, Ahrens R, Chesrown SE, Hendeles L.Nonprescription racemic epinephrine for asthma.J Allergy Clin Immunol Pract.2014;2(5):575-8. doi:10.1016/j.jaip.2014.02.014
DailyMed.Asthmanefrin - racepinephrine hydrochloride solution.
Royce SG, Cheng V, Samuel CS, Tang MLK.The regulation of fibrosis in airway remodeling in asthma.Mol Cell Endocrinol.2012 Apr 4;351(2):167-75. doi:10.1016/j.mce.2012.01.007
American Lung Society.Assess and monitor your asthma control.
Reddel HK, Ampon RD, Sawyer SM, Peters MJ.Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey.BMJ Open.2017;7(9):e016688. doi:10.1136/bmjopen-2017-016688
National Institutes of Health, National Heart, Lung, and Blood Institute.Guidelines for the diagnosis and management of asthma 2007 (EPR-3).
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