Since this information was first posted November 2010, a few things have changed.
- My book is no longer “upcoming.” It’s available for purchase on this very website!
- Primatene Mist is no longer available OTC, though it may be again someday. The manufacturer is still hopeful that a new version with an environmentally-friendly propellant will be approved.
- For a few years, Asthmanefrin was widely available as a potential replacement. However, FDA concerns over drug and device safety resulted in a recall of the product.
- Primatene Tablets remain on the market. Though likely less effective than Primatene Mist, and still with a significant likelihood of systemic reactions (increased heart rate or blood pressure, or nervousness or jitteriness), the tablets are probably your best bet for OTC asthma prepping.
- The remainder of the article remains current.
Part one of this series (Asthma and COPD – Part I – Introduction) discussed the different types of asthma, avoiding triggers, and home monitoring.
Today’s post, excerpted from my upcoming book, Armageddon Medicine, discusses over-the-counter treatments that may be useful for asthmatics, and are available for stockpiling now.
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Caffeine is the most universally-available chemical to open the airways. A review of the medical literature by the Cochrane collaboration concluded that the ingestion of caffeine offers modest improvement in lung function for 2 to 4 hours after consumption (a 12-18% increase in FEV1). Doses as low as 5 mg/kg body weight were shown to have an effect. For a 70 kg (152 pound) man, that’s 350 mg of caffeine, or about 2 strong cups of coffee or black tea. Caffeine is also available as 200 mg tablets, generally sold to promote wakefulness.
It’s amazing that Primatene Mist (epinephrine) is available over-the-counter. Epinephrine used to be a mainstay of asthma treatment. It is certainly effective, but quite likely to cause rapid heart rate and jitteriness. It is the same as adrenaline, which causes the rush that you feel when someone jumps out of a dark corner and scares you. Doctors advise patients against the use of this medication, not so much because it is ineffective, but because of side-effect concerns including rapid heart rate, increased blood pressure, and nervousness. Another drawback is the short-acting nature of the drug, lasting only a few hours. Unless the medication is released in a new formulation, it will be withdrawn from the market as of December 31, 2011.
Primatene Tablets containing ephedrine are currently available over the counter. Related to pseudoephedrine, ephedrine behaves similarly, with a somewhat greater risk of the same side-effects.
Pseudoephedrine is one of my favorite medications. It decongests the airways from top to bottom, alleviating symptoms of sinus pressure, ear pressure, nasal congestion, and lung congestion. Although patients now have to sign for the medication (thanks to the methamphetamine labs), it is an excellent drug to stock up on. Common side-effects include insomnia, anxiety, and rapid heart rate or palpitations. Some patients find it too drying, although this effect is dose-related. A few patients have the paradoxical side-effect of drowsiness.
Antihistamines help dry up secretions and minimize the body’s reaction to substances to which a person may be allergic. If you suffer from mucus accumulation (phlegm) as part of your obstructive lung disease, you may find an antihistamine helpful. Note: some patients have the opposite reaction, and find the thicker, drier mucus more difficult to expel. These patients may do well with an expectorant (guaifenesin or SSKI). Patients with allergic asthma do particularly well with antihistamines. The over-the-counter products are essentially as good as prescription medications. Benadryl (diphenhydramine), Claritin (loratadine), Zyrtec (cetirizine), and chlorpheniramine are all available OTC in inexpensive generic form. Claritin and Zyrtec are less sedating than Benadryl or chlorpheniramine. Some patients have the opposite effect and feel ‘wired’ when using an antihistamine.
NasalCrom is a nasal inhaler for nasal allergies. It contains cromolyn sodium, one type of controller medication useful in alleviating chronic asthma. When originally released, it was available only by prescription. (The lung inhaler and eye drop remain by prescription only.) Although NasalCrom is intended for nasal allergies and is inhaled through the nose, some of the medication reaches the lungs. Used on a daily basis, and inhaling deeply as the mist is sprayed, NasalCrom may decrease the overall severity of chronic asthma symptoms. Other advantages are the cost (less than $20 for a bottle containing 200 sprays) and excellent safety profile, even at the high end of dosing. This medication will not cause jitteriness, rapid heart rate, drowsiness, nor insomnia.
Copyright © 2010 Cynthia J. Koelker, MD
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