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Asthma: Over The Counter Treatment (cont.)

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How do over-the-counter (OTC) asthma medications work?

Epinephrine acts by relaxing the muscles of the airways, thereby opening up the airways and allowing air to flow in and out of the lungs more easily. Ephedrine also relaxes the muscles of the airways. Essentially, these drugs work by stimulating the beta sympathetic receptors. However, these agents are not very specific and stimulate all beta receptors, resulting in increased side effects, including elevate blood pressure and heart rate.

What factors should be considered in choosing and using OTC epinephrine or ephedrine?

Despite the development of newer medications, epinephrine and ephedrine remain available as OTC medications. The choice of epinephrine or ephedrine should involve consideration of several factors. Most importantly, the asthma should be mild and less frequent, defined as occurring less than once per week and resolving almost immediately. OTC epinephrine or ephedrine is best used under the guidance of a physician, if used at all. A patient should seek medical attention and prepare to switch to a prescription asthma medication in most cases, but especially if:

  1. moderate to severe asthma develops;
  2. frequent or regular doses of epinephrine or ephedrine are needed to relieve symptoms;
  3. episodes of asthma occur once or more per week; or
  4. asthmatic episodes develop at night.

OTC epinephrine is available in various concentrations for oral inhalation or as a solution in vaporized form (nebulization). Both forms may or may not contain alcohol or sulfite as preservatives. For example, AsthmaHaler Mist does not contain alcohol. Alcohol and sulfite preservatives may trigger an asthma attack, and therefore, patients whose asthma is sensitive to these preservatives should read product labels carefully. The nebulized epinephrine solutions may or may not require diluting with a separate saline (salt) solution before use. Several saline solutions are available OTC in various concentrations. Again, careful reading of the label will provide information about combining an epinephrine solution for nebulization with a specific saline solution. Oral epinephrine is unavailable because it is rapidly broken down in the digestive system before it can reach the lungs. Once inhaled, epinephrine should provide rapid relief of symptoms (within 5 to 10 minutes) and continue working for 1 to 3 hours. Good inhaler and nebulizing techniques are critical in the use of epinephrine. If epinephrine is used frequently, tolerance to its effects occurs; that is, repeated inhalations provide progressively less and less benefit. Previously chlorofluorocarbons (CFCs) were used as the propellant for inhaler therapy. These have been banned and replaced by alternative propellant, hydrofloroalkane (HFA). The CFCs were felt to contribute to damage to the ozone layer.

OTC ephedrine is available only as an oral medication in combination with guaifenesin as caplets, tablets, or syrup. (Guaifenesin is an expectorant that reportedly loosens mucus in the airways and facilitates its removal by coughing, though this has never been proven conclusively.) Caution should be used when first starting these products since they occasionally irritate the airways of some patients and may make the asthma worse. OTC ephedrine should provide relief of symptoms within 15 to 60 minutes and may continue to be effective for 3 to 5 hours. Continued use of ephedrine, like frequent use of epinephrine, leads to tolerance.

Neither epinephrine nor ephedrine should be continued if thick mucus or sputum (colored mucus) develops and/or a persistent or chronic cough occurs with the asthma. These may be signs of infection in the lungs and require immediate medical attention. If OTC asthma drugs do not relieve an episode of asthma within 10 (for epinephrine) or 60 minutes (for ephedrine) or the symptoms worsen, the patient should seek immediate medical attention. Repeated use of these agents should be strongly discouraged, unless under direct medical supervision.

Medically Reviewed by a Doctor on 7/12/2017


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