Affordable prepping for asthma and COPD

A reader’s question got me thinking today. With albuterol inhalers costing about $50 a pop, not to mention maintenance inhalers at $100-$200 per month, and with Primatene Mist now off the market, is there any way an asthmatic can prep on a budget?

If your doctor is agreeable, the answer is yes.

Ipratropium nebulizer solution, as well as several forms of albuterol (2-mg and 4-mg tablets, syrup, and nebulizer solution), are all listed on the $4 prescription drug lists.  The nebulizer solutions do require a nebulizer, but these are available without a prescription for as little as $40, though $70 to $100 is more typical.

A good supply of prednisone in several strengths is available for under $10 as well.  Prednisone is best reserved for flares of asthma or COPD. Daily use can lead to elevated blood sugars, weight gain, stomach irritation, and weak bones.

Aminophylline, an older asthma medicine, is equally inexpensive.  In the days before the plethora of inhalers we know enjoy, aminophylline was the mainstay of asthma therapy.  It has been given both orally and IV, and is prone to cause nausea, rapid heartbeat, insomnia, anxiety, and tremor – especially in higher dosages (much like caffeine, to which it is related).

It probably would not be too difficult to get your doctor to prescribe the inexpensive nebulizer solutions.  Patients often keep these on hand for exacerbations of asthma or COPD (when properly instructed in their use).  The prednisone and/or aminophylline might be a hard sell – again that depends on the doctor-patient relationship and is a matter of trust. (see

Caffeine and pseudoephedrine are weaker bronchodilators but have the advantages of being both inexpensive and available over the counter.

The trend in asthma care today is to use inhalers (and Singulair) almost exclusively, despite the cost, which often exceeds $200/month for the self-pay patient.  Stockpiling a year of extra medicine could easily cost thousands of dollars, at least using current treatment.  For end-of-life-as-we-know-it concerns, it may be more cost-effective to purchase the older, inexpensive medications listed above if your doctor is agreeable.  Purchase a peak flow meter as well, while you’re at it.  Future posts will address treating asthma on your own.

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Copyright © 2012 Cynthia J. Koelker, MD

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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4 Responses to Affordable prepping for asthma and COPD

  1. gayle says:

    I have chronic bronchitis, 8-9 years now, with asthma symptoms too. Been using herb called “slippery elm” 1 capsule in the morning & 1 at night. Works like guaifenisen or musilac (spelling probally wrong). The cost is about 1/10th the price & works great. No known side effects & can be taken with other meds. Breaks down mucus and make it easier to cough up. (you can actually tell within 5 days your taking it) I also use ephedrine and it is getting harder to get

    • Thanks for the comment, Gayle. As she says, slippery elm has been used for coughs, colds, skin conditions, and GI problems. Since it grows in North America, it is a good option to consider.

      For an excellent review, see this link to University of Maryland’s Medical Center:

      A note on ephedrine – it certainly does work as a bronchodilator (airway-opener for asthma or bronchitis) and decongestant, but the reason doctors tend to avoid it is that it is more likely than prescription drugs to cause side-effects, such as rapid or irregular heart rate and elevated blood pressure, with increased associated cardiovascular risks.

  2. Jake, PharmD, PhC, BCPS, PhD says:

    GUAIFENESIN is sold OTC without restrictions. You may wish to try PHENYLEPHRINE HCL instead of PSEUDOEPHEDRINE HCL. Most folks claim it works just as well. Have you ever tried the Rx FLONASE (fluticasone proprionate)? It will last about 2 months, has a generic formulation, and acts as an inhaled-steroid.

    You may find some relief with that product. While not typical amphetamine-drugs themselves…both Pseudoephedrine HCL & Phenylephrine HCL act in a similar manner (even dilating pupils). I think combining an OTC such as ALLEGRA (fexofenadine HCL) with an Rx for a nasal-corticosteroid will provide better relief, faster, longer-lasting, and cheaper. Just an idea for you.

    (I wouldn’t recommend the Caffeine HCL as a nasal-decongestant as chronic daily use can lead to adrenal-exhaustion. It works by causing your body to release the ‘fight-or-flight” hormone ADRENALINE..or EPINEPHRINE).

  3. For Alabama: Until last year pseudoephedrine was OTC. Then, we had to sign for it with a limit of two every two weeks. On March 16,2012, the governor signed into law–it will be prescription med starting in Sept 2012.

    The reason: meth labs use it to cook their drug. I think it is meth…lol.

    Now, I can have one package of OTC pseudoephredine each month. I now have 48 tablets of 30 mg, taken two a day. So, I can get a 24 days but run of this med each month. Most months, that is sufficient. But, I worry what I will do when it is no longer available.

    You did not mention guaifenisen (spelling?) for chest congestion; since I have chronic bronchitis, I wonder why it is not mentioned..

    I don’t use pseudoephedrine for my chest, just sinus problems.

    I cannot get a stash of either for various reasons…so I suppose I must stay well.

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