Wednesday, September 19, 2012

A Farewell to Primatene® Mist (Almost)

In December, 2011, in accordance with its efforts to eliminate sale of CFC-containing inhalers because of the harmful effects of CFCs (chlorofluorocarbons) on the environment, the FDA banned the sale of Primatene® Mist, the over-the-counter (OTC) inhaled bronchodilator containing epinephrine. Suddenly, no low-cost bronchodilator could be purchased in the US without a prescription. The era of Primatene® Mist availability spanned 50 years, and it was estimated that as many as 2-3 million units were sold each year.

Is this a sad or happy farewell? Many would argue that its elimination is a good thing and long overdue. You may remember the headline stories from several years ago about Krissy Taylor, a young model, found dead clutching her Primatene® inhaler. She had self-treated asthma and died not from toxic effects of the medication but from inadequately treated asthma. It is a story that has likely been repeated many times, even if not always with such a tragic and fatal outcome: persons over-relying on bronchodilator therapy, self-treating their asthma without the guidance of a healthcare professional, developing worsening airflow obstruction due to inflammation of the airways (swelling and mucus plugging) while relying on a medication like Primatene® whose only effect is relaxation of the muscles surrounding the bronchial tubes. Making a bronchodilator available at relatively low cost without a prescription makes this scenario all the more possible.

There would be no debate about the benefits of eliminating sale of an OTC bronchodilator were prescription bronchodilators with ozone-friendly HFA (hydrofluoroalkane) propellants available in a low-cost, generic version (which they are not) and were primary care providers readily accessible to all asthma sufferers (which they are not), so that prescription medications could be quickly prescribed and obtained in the context of sound medical advice about asthma treatment. The idea that someone with asthma who is having difficulty breathing might not obtain relief because they cannot get the help of a medical provider and/or cannot afford the cost of a prescription bronchodilator is abhorrent to all. An important first step to solving this problem is once again marketing a generic albuterol (now albuterol-HFA). Inhaled albuterol likely is safer, more potent, with a longer duration of action than epinephrine.

While we engage in reasoned debate on this subject, a pharmaceutical company (Nephron) has found a commercially-driven solution: market a form of epinephrine (racemic epinephrine or racepinephrine) as a liquid delivered by a small hand-held atomizer device. It seems a step back into history, before the invention of metered-dose inhalers, when asthma medications like isoproterenol were delivered using a bulb atomizer. The product (AsthmaNephrin®) and the atomizer device (EZ Breathe®) are already in pharmacies across the country … and available without a prescription. For better or for worse, it appears that the marketplace has won out … again.


  1. Asthma sufferers who experience adverse side effects from conventional medicines are sometimes forced to search for alternative treatment. Asthma treatment

  2. i am from peru my son is 6 years old and have asthma like me, his grandmother lives in the U.S. and brought EZ BREATE ASTHMANEFRIN ATOMIZER and I was looking and I found this in my blog is that it is a medicine without a prescription, but I wonder if the EZ BREATE ATOMIZER be used with serum and Fenaterol solution which is used for spraying here, I have the complication that sometimes you have to nebulizarlo at night and take it to the clinic is very far and quiusiera know if that device I can use with another drug I Know. I'd appreciate your help is very important.

  3. I am a respiratory therapist and many of us have bought them. I would not use asthmanefrin unless I had no other drug available as it ia not the drug of choie, but that said.....the atomizer is just can put any liquid in it and it will turn it into a mist so we use the albuterol in it or combivent or is so small you can carry it in your purse or lunch box, etc and if you travel it is easy to take on the plane. Be sure though that you carry an extra set of batterys somewhere as it works off batteries and it would be awful to run low. We have not tested it long enough to see how much time the batteries are good for, as none of us use it regularly, we bought them for back up for our families.....the liquid works much better than an inhaler/HFA if you are really having a bad attack because in my opinion and I work in an ER a lot, you can't take a deep enough breathe to get the meds into your lungs and it has to get there to work. You have more opportunity to get the meds in with the mist. Any real asthmatic will probably agree with me.

  4. Wow is just the simple word that may explain that how much I liked it. It was nicely stuffed with the material I was looking for. It’s great to be here though by chance.