Asthma: Over-the-Counter Treatment
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- Asthma introduction
- What is asthma?
- What medications are used to treat asthma?
- How do over-the-counter (OTC) medicines for asthma work?
- What factors should be considered in choosing and using OTC epinephrine or ephedrine?
- What side effects and drug interactions are there with OTC asthma medicines?
- What are additional measures in the management of asthma?
- Find a local Asthma & Allergy Specialist in your town
Asthma has often been characterized as a disease in which there is a brief, temporary narrowing of the airways in the lungs, referred to as bronchospasm. This is only part of the picture. It is now believed that the main problem in asthma involves inflammation and swelling of the airways. These changes make it easier for bronchospasm to occur. This narrowing prevents air from moving in and out of the lungs easily. As a result, an asthmatic patient has episodes when breathing is difficult. An asthmatic episode can resolve spontaneously or may require treatment.
It is crucial to understand that over time the airway inflammation associated with asthma can result in permanent remodeling of the airways. Asthma may progress into the category of disease known as chronic obstructive pulmonary disease (COPD). Therefore, if an episode of bronchospasm, asthma attack, or chest tightness persist for a week, it is imperative to be evaluated by a physician. The available over-the-counter (OTC) medications treat bronchospasm primarily and have little, if any, effect on airway inflammation. Airway inflammation is treated by prescription medications such as Montelukast (singulair) and inhaled corticosteroids (steroids).
Asthmatic patients and their physicians may select from a wide variety of prescription medications. This is not true for OTC medicines, which are limited to epinephrine (adrenaline) and ephedrine. In addition, many asthmatic patients should not use epinephrine or ephedrine because of their relatively weak effectiveness or side effects.
To decide whether or not an OTC epinephrine or ephedrine product may be useful, patients should understand:
Learn more about: ephedrine
- the abnormal conditions that exist in the airways of asthmatics;
- the effects of epinephrine and ephedrine;
- the specific factors that should be considered when choosing and using epinephrine and ephedrine; and
- the side effects of these drugs.
The advantages of using OTC medications for asthma include their affordability and accessibility (lack of need for a prescription and/or health insurance approval). Unfortunately, these medications are less effective at controlling asthma and sometimes can be more dangerous.
Recently, the FDA published safety concerns about the new medication Asthmanefrin and the EZ Breathe atomizer. They report complications such as chest pain, nausea and vomiting, increased blood pressure, increased heart rate, and coughing up blood. Even more disconcerting, they have reports of a choking hazard from a washer being dislodged during atomizer use.
Most pulmonary and allergy specialists would discourage the use of these OTC medications unless symptoms are extremely mild and infrequent.
What is asthma?
The cause of asthma is unknown. More is known about the abnormal conditions that occur in asthma. These conditions include:
- hyper-responsiveness(contraction) of the muscles of the breathing airways in response to many stimuli such as exercise or allergies (for example, drugs, food additives, dust mites, animal fur, and mold);
- inflammation of the airways;
- shedding of the tissue lining the airways;
- increased secretion of mucus in the airways; and
- swelling of the airways with fluid.
All of these conditions narrow the airways and make breathing difficult. Symptoms of asthma include wheezing (the hallmark of asthma), coughing, difficulty breathing, and tightness of the chest. Asthma is diagnosed by the presence of wheezing, but it can be confirmed by breathing tests (spirometry) that evaluate the movement of air into and out of the lungs.
What medications are used to treat asthma?
EEpinephrine and ephedrine once were the only effective medications for treating asthma. Beginning in the 1980s, newer medications were introduced that target more of the abnormal conditions in asthma and do so more effectively than epinephrine or ephedrine. For example, prescription inhaler forms of short-acting beta2-agonists (SABA), including albuterol (Proventil, Ventolin, ProAir), and metaproterenol (Alupent), inhaled corticosteroids (ICS) including Beclovent, Flovent, Qvar, Asmanex, and Aerobid, anticholinergics (ipratropium and teotroprium bromide [Atrovent], Spiriva), and other medicines are now widely used because of their greater effectiveness and fewer side effects. The use of inhaled anti-inflammatory medications that include steroid agents such as fluticasone, budesonide, beclomethasone, and flunisolide has become the mainstay of initial asthma therapy. Unfortunately, none of these medications are available without a prescription. Often, these medications are also prescribed in combination with a long-acting beta agonist (LABA), such as salmeterol or formodaril. Some of the more common versions include Advair, Symbicort, and Dulera.
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