Good news for asthmatics: Obama administration set to ban over-the-counter inhalers to save ozone layer

““Everybody knows that it makes no sense that you send a kid to the emergency room for a treatable illness like asthma, they end up taking up a hospital bed, it costs, when, if you, they just gave, you gave them treatment early and they got some treatment, and a breathalyzer, or inhalator, not a breathalyzer. I haven’t had much sleep in the last 48 hours.”” –Barack Obama, 9 October 2008

Wonderful news from the environmental do-gooders in Washington: the Obama administration is poised to ban over-the-counter breathalyzers, I mean inhalators, I mean inhalers in order to save the ozone layer

Remember how Obama recently waived new ozone regulations at the EPA because they were too costly? Well, it seems that the Obama administration would rather make people with Asthma cough up money than let them make a surely inconsequential contribution to depleting the ozone layer:

Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government’s latest attempt to protect the Earth’s atmosphere.

The Food and Drug Administration said Thursday patients who use the epinephrine inhalers to treat mild asthma will need to switch by Dec. 31 to other types that do not contain chlorofluorocarbons, an aerosol substance once found in a variety of spray products.

The action is part of an agreement signed by the U.S. and other nations to stop using substances that deplete the ozone layer, a region in the atmosphere that helps block harmful ultraviolet rays from the Sun.

But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for around $ 20, whereas the alternatives, which contain the drug albuterol, range from $ 30 to $ 60.

As Anthony Watts observes, “Let the hoarding begin“:

The eco-world has gone beserkers with this one, even CBS News is asking: Why? Me too especially since global ozone is predicted to recover [according to a 2004 EPA Report].

…What will really happen is that this will turn regular people and children into scofflaws, and they’ll buy over the counter inhalers in other countries like Mexico and have them shipped here. It will be another giant sucking sound.

So when some kid dies in 2012 because they couldn’t get access to an inexpensive, over-the-counter inhaler, let’s all give thanks to President Obama — because that’s one less ozone destroyer that we have to worry about.

Good Bye Primatene Mist

As reported today by the Washington Post, Primatene Mist’s days are numbered. The FDA announced today that “the only over-the-counter asthma inhaler sold in the United States will no longer be available next year as part of an international agreement to stop the use of substances that damage the environment.”

This is because, similar to the old albuterol meter dose inhalers, Primatene Mist uses a CFC as a propellant which is harmful to the environment. I blogged about this previously (see FDA Announces End for CFC-Propelled Inhalers Asthma inhalers and More on Asthma Inhalers ).

However, the loss of Primatene Mist is a good thing in my opinion. Primatene Mist is epinephrine. It is a bronchodilator, which is why it relieves the symptoms of asthma. However, it is quite dangerous, especially without a prescription. First, it is not just a beta 2 agonist like albuterol which works almost exclusively on beta receptors in the lungs. It also aftects beta 1 receptors in the heart and alpha receptors in the blood vessels. The primary use of epinephrine is medicine today is to give it to patients who are a risk of immediate death in order to restart their hearts. In addition, having any bronchodilator, even albuterol, over the counter, is a bad thing. We know that increased albuterol use is associated with increased ER visits, hospitalizations and even death. But at least we can monitor albuterol use, because it must be prescribed by a physician. We have no way of knowing if a patient is taking too much Primatene mist until they are dead.

Under a physician’s supervision, with a proper asthma plan and additional chronic maintenance medications for asthma, such as inhaled corticosteroids, bronchodilators can be used safely and effectively. However, over-use of these medications especially in the absence of inhaled corticosteroids is dangerous. This is why I never write an albuterol prescription with any refills. If your asthma is well controlled, one albuterol inhaler should last you a year and you shouldn’t need refills. If you are refilling the albuterol more than one time in a year, by the NIH’s criteria, your asthma is not under control and you may need to change to a stronger daily medication (for example, switch from Singulair to an inhaled corticosteroid or ICS, or switch from an ICS to an ICS/LABA combination).

For those patients without prescription insurance who relied on the relatively low cost of OTC Primatene mist, be advised the GSK makes a sample size of Ventolin HFA (60 inhalations) that is only $ 9 out of pocket (regardless of insurance) at most major retail pharmacies. This will of course require a doctor’s prescrition, but I believe that is a good thing for the reasons stated above.