How to breathe easier

Asthma sufferers have long relied on inhalers for relief from wheezing or coughing attacks. But as of Dec. 31, Primatene Mist -- the only available over-the-counter asthma inhaler -- was taken off shelves because of its adverse effect on the environment. Other inhalers are available, but these require a doctor’s prescription.

Some people with asthma aren’t happy about the change, but lung doctors and asthma specialists agree that Primatene Mist wasn’t the best option for patients anyway. The disease, they say, can be controlled more effectively with prescription medication than with an over-the-counter product.

Still, patients who used Primatene Mist may not know where to turn. Here’s the latest information about what you can do if you’re one of them.


What is Primatene Mist, and why was it withdrawn?

Primatene Mist is an inhaler that uses the active ingredient epinephrine. During an asthma attack, it opens the airways and allows the user to breathe. Like other inhalers designed for these critical moments, Primatene Mist is known as a rescue inhaler.

Its discontinuation didn’t have to do with its effectiveness. Rather, Primatene Mist was withdrawn from the market in the United States in accordance with the Montreal Protocol on Substances that Deplete the Ozone Layer, drafted in 1987. That treaty determined that chlorofluorocarbons (CFCs), which include the chemical used to propel inhalants in Primatene Mist, were damaging the ozone layer and should be discontinued. Inhalers using CFCs have since been replaced with ones that use the non-CFC chemical hydrofluoroalkane (HFA).



How many people, and who, used Primatene Mist?

Between 2 and 3 million people used Primatene Mist each year, according to a 2006 estimate by Wyeth Pharmaceuticals, which used to manufacture the medication.

According to the Centers for Disease Control and Prevention, about 25 million Americans have asthma. Sandra Fusco-Walker, director of patient advocacy at the Allergy and Asthma Network/Mothers of Asthmatics, noted that it’s difficult to know who was buying Primatene Mist and why, since it was sold over the counter.

Despite its accessibility, many doctors say the medication wasn’t a good option for patients.

“Primatene Mist does not treat asthma -- it treats symptoms that can come from asthma,” said Dr. Kyle Hogarth, an assistant professor of medicine and the medical director of the pulmonary rehabilitation program at the University of Chicago Medical Center.

The danger in treating only symptoms, he said, is that repeated asthma attacks can permanently damage the lungs. Poorly controlled asthma can progress to a point where, “in their 40s and 50s, [patients] have the lungs of someone who is 80 or 90 who has smoked.”

For that reason, the goal of asthma care isn’t to react just to attacks -- it’s to prevent attacks in the first place. That’s generally done with daily medications, such as inhaled corticosteroids, which keep the airways from becoming inflamed. Ideally, Hogarth said, rescue inhalers shouldn’t be used more than twice a week, at most.


What are all those people who used Primatene Mist doing now?

Some patients have stocked up on the medication. “I ordered some online,” said Los Angeles resident Kate Eisenhower, 46, who has had asthma since the age of 10 and said she relies on Primatene Mist when she is unemployed or doesn’t have access to healthcare.

But many patients have switched to prescription inhalers that contain the active ingredient albuterol, all of which are now made with HFA instead of CFCs. Like Primatene Mist, they’re used at the onset of an asthma attack to relieve symptoms. Albuterol targets the root of an asthma attack more precisely than Primatene Mist’s epinephrine, said Dr. Asha Devereaux, a clinical pulmonologist in San Diego.

Fusco-Walker added that patients who are used to CFC inhalers may have a slight learning curve in transitioning to HFA inhalers. “They need to be cleaned differently, and they have to be primed four times,” she said. According to the Asthma and Allergy Foundation of America, HFA inhalers also taste different and have a less powerful puff of air.


What if you don’t have health insurance?

There are a number of options. Many cities and towns have community health centers that are funded by county, state or federal dollars and can treat asthma at a reasonable cost.

Jehni Robinson, chief medical officer of one such center, the Saban Free Clinic in Los Angeles, said that patients who come to the facility pay anywhere from nothing at all to $50 a visit, depending on their income. The clinic can treat their illness from diagnosis to follow-up.

“We do a comprehensive analysis of their asthma,” Robinson said, “and then an on-site dispensary can give them the medication they need.” Patients are encouraged to return to the clinic within the next few weeks or months to check in with their doctor.

Many pharmaceutical companies also offer patient assistance programs, Hogarth said. The Allergy and Asthma Network/Mothers of Asthmatics suggests visiting websites such as the Partnership for Prescription Assistance ( or RxHope ( www.rxhope .com) for more information about such programs, or asking a doctor or pharmacist for advice.

Devereaux added that shopping around and looking for deals on the Internet can make a big difference.

“There are lots of prescription drug coupons available online, and many of the manufacturers are offering discounts,” she said. “Some large retailers, such as Wal-Mart or Costco, are offering rescue inhalers at 50% of the price of Primatene Mist.”


Is a CFC-free version of Primatene Mist in the works?

It’s not clear. The FDA states on its website that it can’t comment on pending drug applications, and calls to Amphastar Pharmaceuticals, the makers of Primatene Mist, were not returned.