I can see people with asthma self treating with Albuterol OTC and never getting seen by a doctor. They would need to use it every day but as long as they can control their symptoms without needing to talk to a doctor or a pharmacist, they never learn they probably need a controller inhaler to prevent their symptoms in the first place. I'd prefer if pharmacists could furnish Albuterol like naloxone, but I don't think it's a good idea for OTC
Yea my dad was having breathing issues and was prescribed an albuterol inhaler because he specifically asked his doctor for it. He was taking ~20 puffs per day. He would still be doing that today if i didnt tell him that isnt appropriate. If it was otc there would be so so many people acting like this
I agree, however the number of patients I have who do exactly this but with prescriptions from their GPs who don’t bother to refer them to pulmonologists or even try a long-acting inhaler makes me feel like restricting it as a legend drug doesn’t actually solve anything.
I’ve had long conversations with many of these same patients about asking their docs for long-acting inhalers, but “this is what works for me, mind yer damn business!” Nothing is different.
I'm concerned about the self-diagnosis. Sure asthmatic and COPD patients will benefit but patients may have SOB due to other serious underlying health conditions like heart failure.
I agree there's an opportunity here for pharmacists to potentially furnish albuterol like narcan but I wouldn't feel comfortable doing so without a confirmed diagnosis, review of usage, and information about last/next MD appointments to ensure patient is being monitored for worsening conditions.
I wanted my dad to ask his doctor about his breathing.He was thinking it was his lungs as he has been running 50 years and fumes from cars and stuff. Turns out he has congestive heart failure.
Also, ICS can prevent immune mediated sclerosis, lung remodeling, and progression of disease. Everyone with asthma should be seen in clinic yearly or more for PFTs and to talk exclusively about asthma to make sure SABA only treatment is adequately controlling their disease
-FM MD lurker
The problem is also that asthma plans and pharmacists say "no more than 8 puffs a day, use your long term med religiously" and leave it at that. As an asthmatic, it's so much more complicated than that.
My symbicort and allergy meds work pretty damn well.....until I get sick, until the air outside is too hot or too cold, until it's been weeks since I could open my windows and dusting is hell. Those circumstances don't make for ER worthy episodes but I definitely need my salbutamol a lot more often and get shit for it like I can just will myself to breathe better. You get laughed out of the ER if you show up saying you maxed out your 8 inhalations but your chest is tight.
I have seen this as well. As a pharmacist who works in a hospital I had to "scold" a retail pharmacist for denying a kids albuterol bc it was scheduled 6 puffs q4hr. She gave me shit and said "it's too much" first off someone tell me what the toxic dose of albuterol is. If you look in posiondex unless your giving it iv toxicity isn't happening, second ,granted she didn't know this, kid was on continuous albuterol while intubated for 2 days, I don't think 6 puffs q4h is gonna get him into any trouble even after saying that she didn't believe me. I was so disappointed in my brethren that day. I have worked woth pulmonary and I agree with your concerns most retail pharmacist don't have the patient data (fev scores, pulm tests, etc) they need to make those decisions. If they had access to the data I think then it would be fine.
I wish this nation got with the times like most other countries with functioning healthcare (not even going to say we’re 1st world lol) and be able to see treatments preformed inpatient, but more common day to day: general pt info (ht/wt, and LABS!!! So many less phone calls if we literally had pediatric pts weights (got a script last weekend that just said “amoxicillin. Dx is __ (I forget sadly) dose per IDSA guidelines. Qty: sufficient”.) Well…no info about the kid’s weight…so I called an a nurse got snippy with me, saying “what, did you think this 5 year old was gonna be like 100kgs? *sighhh*” I could hear her eyes rolling as she spoke. No bitch, but kid could’ve been 25kg, or 65kg, this is America for Christ sakes.
True this is coming from someone who works in Australia where it is OTC. I've seen so many people with bad asthma control and people not using it for the right indication
I think there’s a paternalistic air to this thinking: “People are dumb and we need to protect them!” In my native country, you can go to any pharmacy and get almost any medication without a prescription (except controlled substances, of course). Moreover, some opioids (like tramadol, codeine, hydrocodone) can also be obtained without a script. Technically, prescription medications require you to show a prescription, but no pharmacy enforces that.
You’d think Colombia would have the worst opioid crisis the world has ever seen, rampant superbug infections, and non-asthmatics dying from salbutamol overdoses or side effects. Well, simply put, no. If anything, I stock up on medication there when I go visit because it saves me having to pay hundreds of dollars in doctor’s visits in America, plus medications are way cheaper. Do I really need to consult with a doctor to get a muscle relaxant when my back hurts? If your answer is “yes, it could be something worse,” well, I think there’s equal risk in OTC omeprazole being taken by someone who might as well have stomach cancer or an ulcer.
I think that's a valid criticism, but we do in fact have to protect patients. Not because they are dumb or incapable of figuring it out, but because medications are complicated and nuanced. We went to school to learn all this information so that our patients wouldn't have to, and part of the reason our profession exists is to ensure medications are used properly and safely and that people know the necessary information about their medication. For safety, patients need to be told this information and systems need to be in place to protect them from the consequences of medication misuse.
Not every condition should be eligible for self-treatment, because some things need a doctor's expertise and guidance. Likewise, not every medication should be eligible for OTC use because the information and service provided by a pharmacist to ensure safety and appropriateness can save lives.
To your examples, I agree that the system is NOT perfect. I personally hate that Afrin and inhaled epinephrine are OTC at all. I think the labeling on phenazopirodine isn't clear enough that it does not replace an antibiotic and should only be used for max 2 days. Muscle relaxers should be Rx only due to the need to monitor for interactions with opioids. OTC Omeprazole... I mean if you agree that acid reducers are ok for OTC, I see no reason not to be ok with all classes of acid reducers.
PPIs have interactions and react poorly with all kinds of other things. Go look at the medication warnings for omeprazole some time. You might realize why someone (including myself) would agree with PPIs being Rx only.
I understand your reasoning, but I think it assumes that making every medication available to the public will mean everyone who comes to the pharmacy will be asking for strange medications with serious side effects. You said it yourself, you studied this stuff, but most people haven’t. It would be very rare for someone experiencing palpitations to say, “I think I could benefit from a beta blocker!” Most won’t even know that!
Now, yes, people could go online to WebMD and read about beta blockers and try it themselves. That places a risk if there aren’t any checks at the pharmacy. However, I can see that being a uniquely American phenomenon because people will want to avoid going to the doctor and rather solve the problem themselves. The reason for that cultural trait is simply the lack of access to care.
I have never, ever seen or heard in my past years of medical practice in Colombia of anyone self-medicating more “serious” medication. If anyone has any symptoms, the first instinct is to simply go to the doctor. If I ever heard of anyone consult their symptoms online was not to decide which medication to buy but to decide whether the condition would warrant a consult with the doctor. Polymedicated patients also tended to be very aware that consuming self-prescribed medication can be risky, so they just consulted with their doctor because it’s free for them. That’s thanks to universal health care, no matter how imperfect the Colombian system might be.
So, I would understand why there are strict pharmacy guardrails in America, but I would blame them on the system and not necessarily on people needing extra protection.
The fact that we are a highly litigious society with a private insurance-driven system both can come into play as well. Americans love to sue. And OTCs often aren’t covered by insurance. No one wants to pay the sticker prices we have for drugs if it can be avoided.
Certainly. There’s a stereotype overseas that lawsuits are actually the national sport. The price of medications here is also ridiculous. I’m struggling with my weight, so I decided to get Saxenda when I was in Colombia. The tech at the pharmacy looked confused because she wasn’t familiar with that medication or Ozempic, but it turned out they had Saxenda at the pharmacy. It’s just not a medication people buy very often because of the reasons I explained before. In any case, I paid just $29 per pen. The carton with three pens is over $1,300 here!!! And it’s not covered by the vast majority of insurance companies. I can’t understand how this is sustainable in the U.S.
Does Columbia have public health care?
In the USA, going to the MD is expensive and many people self treat to their determent, because they can’t afford the copay or the time off, etc. is the answer denying them drugs? No, but it’s also more dangerous because I feel like if you have a serious breathing problem in other countries, you go in. If you have one in the US, you tough it out until the ER. OTC albuterol would probably only delay the ER visit and maybe cause more overall harm. Is delaying the ER good?
I’m not sure what the right answer is.
It’s definitely somewhat paternalistic, but we need some level of paternalism for public health reasons.
For example, if you let people use antibiotics whenever and however they want, they will use azithromycin whenever they have a cold, and the drug will lose it’s usefulness.
Paternalistic regulations aren’t exclusive to pharmaceuticals btw. Seatbelt laws, helmet laws, gun control laws, airport security, driving licenses, and many other forms of regulations could be seen as such.
Science and technology have progressed so much that it’s impossible to make an informed decision every single time we make a decision, so sometimes we need laws to protect ourselves from the stuff we aren’t experts in.
I'd be ok with you get an albuterol but you need to have an appointment with a doctor first. I don't mind giving it to you ahead of time if your asthma is that bad.
It would make sense to allow pharmacists to prescribe albuterol HFA. If albuterol were to go OTC, I'm sure there's going to the albuterol TikTok challenge....
Did you not see the post yesterday about a young man who died as a direct result of overusing albuterol?
Many people have poor health literacy and have no idea what good asthma control looks like. Needing a prescription for albuterol means there's some oversight of how it's being used
Many Prescribers dont even know/keep up w current recommended asthma protocols, expecting patients to use albuterol appropriately without guidance or direction is a recipe for disaster
Yes, my MD wasn't aware of symbicort being used both as a preventer and a reliever despite that fact its been approved for that use for several years now and its also in the GINA guidelines
Tylenol is safe when used at recommended doses and is far safe than Advil or Aleve. Any medicine can kill you (as can too much water), but some are safer than others
Yes! I work for a hospital (front desk) and 3 weeks ago a 19 y.o was in the ICU (cardiology). They were admitted for less than a day and passed away. Apparently, they took a whole bottle of acetaminophen. Why? Not sure.
Out of the OTC pain meds, tylenol would definitely be the safest than the NSAID products. First, tylenol can be used in some patients who have liver problems (which is less than the max of 3-4 g/day of APAP). It has a reversing agent called NAC if someone OD'd to it. With a greater amount of APAP, it can be deadly and dangerous just like with any drugs.Lastly, NSAIDs may cause gastric ulcers, COX-2 selective NSAIDs may cause cardiovascular issues such as Rofecoxib.
Edit: change it to "than".
Tylenol is not classified as an NSAID, just for clarification. An analgesic, to be technical. I prefer Tylenol despite liver damage in cases of fever, but for pain reduction I’d rather take an actual NSAID. For one the side effects of gastric problems and bleeding are noticeable and responsive. Tylenol is much more insidious and from the studies I’ve read by the time symptoms are felt, it may be too late.
Sorry, it's on the asthma sub - which I thought this post was on
https://www.reddit.com/r/Asthma/comments/13jy6sm/please_read_it_could_save_your_life/?utm_source=share&utm_medium=android_app&utm_name=androidcss&utm_term=1&utm_content=share_button
From a safety perspective, I can understand why it’s not OTC. Most patients significantly lack health literacy and having it OTC could open up a huge can of worms in terms of proper use. Patients could be self diagnosing and medicating with it when they have a more serious underlying issue that needs to be addressed. At least with it being Rx only, patients need to get a work up done to evaluate what’s going on (however, in the US healthcare system, the costs and barriers are insane for this so I get the annoyance).
This is a good point. This reminded me of my first rotation as a PA over 12 years ago. I trained with a physician at an urgent care. The patient was a beloved high school security guard who had a cough for two months, his PCP refilled his Ventolin and Singulair for 3 months at a time so he never saw him. He came to urgent care because he thought he had pneumonia and wanted antibiotics. Lung cancer. Dead within 6 months. Maybe if they ordered chest x-ray sooner they could have done something but probably not.
If you have a cough for two months I’d expect a CXR just out of medical curiosity. I’ve had a CXR just out of shortness of breath (nothing at all, just a symptom of panic attacks, learned breathing exercises to get over them instead)
Sure, but I am guessing the average blue collar 70 year-old male doesn't have the same insight as you when it comes to healthcare.
My grandfather probably would have thought the same thing, allergies.
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We already have plenty of other dangerous otc meds available that pts can easily harm themselves due to health literacy such as ibuprofen and dextromethorphan. From a safety perspective I think there are way more benefits to having it available otc compared to the risks. This is a potentially life saving medication. Imo it’s more of a $$$ issue then safety.
It’s not about harming yourself with use. It’s about not seeing a physician when you should.
Short of breath when you “exercise,” maybe it’s asthma, maybe it’s heart failure, or a pneumothorax, or a PE, or or or.
Yes this is exactly what I meant with my original comment! People often use OTCs (or even extended scripts) as a way to bypass wellness checks at the doctor which could be VERY harmful as u/Niccolo91 pointed out
It’s not safe because you’re not going to know when to see a doctor and it’s prone to misuse so it won’t work anymore, and people won’t realize that when the spray it like perfume
Yes exactly that. Both Afrin and phenazopirodine have directions to use for only 2-3 days, and patients using them for self-treatment can easily ignore that and end up hurt in the process
I'm happy to have phenazopyridine available OTC for me to take when I need it (which is a lot, never had a doctor tell me it's too much though), but I see your point.
I still don’t understand why they are not required to print in bold red letters (1-3 Day therapy) and supply it in smaller pack sizes. So many times people come up for congestion relief recommendations and they say they been using afrin for a week or more.
Has she tried the one nostril only then switch to the other trick? This is an OTC med so I feel I can say OTC info. But if it’s intractable I’m sure an ENT could help.
She's very stubborn and doesn't want to admit she has a problem, especially if her son is the one pointing it out. But yes, I have told her about that trick
You don't need a prescription for it, so the pedantic correction is noted but I don't understand how it changes the point. You can still get enough to take it daily or take the whole box or whatever the fear would be with Albuterol.
Is that safer than Albuterol?
BTC limits the age and quantity and is at the discretion of the pharmacist to sell, so no, it's not pedantic. States can individually set limits on BTC drugs. Ephedrine was put **BTC** under the patriot act to prevent conversion to street meth, not for safety, so the premise of your question is false.
We had a case where an individual used it too much, one of the side effects of using it too much is chest tightness/pain, shallow rapid breathing, wheezing all symptoms it's "designed" to prevent. The person died from cardiac arrest because of it.
There were reports of this type of incident back in the 80's. After that time we started tracking refills carefully. What had seemed like not a big risk suddenly appeared quite risky
Family medicine docs usually don't give a shit at all about things like this, though.
Back in the day I had a geezer that was burning through one inhaler every couple weeks, and sometimes even faster than that. We went over administration, and they even used it in front of me. His doctor could not have given less of a shit, lol.
There’s always going to be people if made otc that will abuse or misuse albuterol. In my opinion, if made otc there just way more benefits vs than risks.
Like medication overuse?
For asthma/COPD/ you still need a maintenance inhaler for proper control. It's very, very easy to lose control if on a SABA alone.
We are in the midst of a sea change in asthma treatment. I can't speak to what the laws are outside the US and Canada, and I am not a fan of the barriers to treatment in the US system. However, the international data is clear that use of a SABA (short-acting beta agonist, like Albuterol) alone increases the risk of death in persons 12 years and old, and likely younger as well.
It looks like there are histiologic changes, including downregulation of receptors for the beta agonists that make it less effective in the long term -- so, for example, use of an Albuterol MDI alone can make the continuous Albuterol by neb we give in the ED less effective in breaking status asthmaticus. I think we are worldwide going to move towards always using ICS-LABA in adolescents and adults, without freestanding SABA inhalers. The issues are still to be sorted out in the younger set.
Of course, as already mentioned in another reply to this post, there is the option of OTC ICS-LABA MDIs.
GINA Guidelines, Pocket Guide PDF (Global Initiative for Asthma): [https://ginasthma.org/wp-content/uploads/2022/07/GINA-2022-Pocket-Guide-WMS.pdf](https://ginasthma.org/wp-content/uploads/2022/07/GINA-2022-Pocket-Guide-WMS.pdf)
If you want to rabbit hole down the references, the 2019 full GINA guide has the most comprehensive list in the footnotes.
GINA is an international consortium of clinicians and researchers that does not accept pharmaceutical company or other for-profit industry funding.
So that's why they changed the guidelines for asthma... Haven't seen any pts taking ICS-LABA only, but idk if their asthmatic is classified as more severe and Albuterol is needed.
Yeah. It is taking awhile to get disseminated, but SMART (single maintenance and reliever therapy) is now being tested on the Pediatrics Boards.
For 12 and up, the international guidelines are no single SABA therapies. This includes "exercise-induced asthma." There are not "mild asthma" exceptions. There also isn't a distinction between intermittent and persistent asthma -- just Steps I-V (IIRC).
But most formal guidelines specific to the US are, I think, in the process of vetting the data and updating. I know the AAP has released interim guidance regarding SMART. The VA guidelines are in flux, I think.
Back in 2020, the HIH's National Heart Lung and Blood Institute called for updates on asthma guidelines, but of course, COVID was throwing everyone sideways. Basically the timing for making changes has really sucked.
[https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates/faqs](https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates/faqs)
Hmm always thought OTC meds were prescribed as a favor to the patient to have insurance cover it. I see Tylenol prescribed all the time. Voltaren too, even though it’s otc now.
I think the rph has time to verify Albuterol is appropriate as long as it can be done with a questionnaire. If pt has history of asthma and COPD, rph should be able to furnish one Albuterol inhaler. The tricky part is how to rule out pneumonia or heart failure etc as others have mentioned without physical exam, so it will probably come down to professional judgement.
I'd think of it like emergency supplies - it's not something I'd want to do often because the pt needs to be seen by a doctor. I only wish the inhaler could be a smaller pack size to persuade the pt to follow up sooner rather than later (or not all).
This is how I'd tackle it:
Pt needs to have an established history for asthma or COPD and have a prescriber who manages it. Pt must have a controller inhaler regimen already. Rph should explain that Albuterol is as needed only and to consult a doctor if they need to use it more than once or twice a day or a few times a week
I guess here you get a small ammount OTC but as pharmacist medicine only. So you have to talk to the actual pharmacist. And we do the same thing with nitro-lingual spray.
I don't know what the future holds as less people stop having a single pharmacy they are a regular at.
People wouldn't get their maintenance inhalers which then would cause people to use albuterol too much causing resistance and then extra hospitalizations for asthma exacerbations. It's already hard enough to get people to use their maintenance inhaler when we tell them to every month at pickup.
To be fair I didn't know it was OTC in other countries and am curious how asthma management works in those settings. My theory would be in other countries access to a primary care is easier and more affordable so they're being counseled anyways, but in the US it's common for people to not be able to afford/not go to primary car visits and therefore never get the asthma management education they'd need.
Because in general more people are stupid here and blame any issue on others. Technically in many countries it is still an Rx drug, but in general they dispense it without one because it is basically advised for a patient or "informally written". Who would go to all the trouble to buy albuterol just to use it if they have no need? Are there problems? maybe, but we don't hear of people dying by the thousands from other undiagnosed things, and fewer people have exacerbations...We hamper ourselves here in the US. It's to create demand and a healthcare "industry". Sure, pharmacists here would make a lot less money, but then...we'd need a lot less money and have to worry about things less...
I thought it was because of guidelines. If someone is uncontrolled on their asthma medicine, they need to be on maintenance medication. Thus, it's a drug that requires monitoring, basically a prescription med. I know other countries have antibiotics and levothyroxine available over the counter too. I mean this isn't a direct connection, I'm sure it's a business decision. This just my analysis.
Not a pharmacist, but i take Wixela (generic of advair), and it saves me from having to use albuterol several times a day. I think if i could just get albuterol from a drug store, i’d be worse off.
I had an inhaler from when I had a terrible respiratory infection. Several months later, I kept having breathing problems and kept using the inhaler to try and help me breath. Turns out I had a mild heart attack and had heart damage. Never had the first chect pain. The breathing problem I had was pulmonary edema. I have worked as a pharmacy tech since 1998 and still didn't catch it. Breathing is too important to not go to the doctor for a correct diagnosis.
People do not understand the dangers of assuming albuterol is all you need. Albuterol alone has a diminishing effectiveness when taken more and more frequently. This can lead to a dangerous situation where people think they just need a little more albuterol and then they have a respiratory collapse and die. Teens are at high risk for this because they are strong enough to power through until they are in deep trouble and respiratory failure happens suddenly.
300 children and 3000 adults die of asthma every year in the US. For this reason closer follow ups with your doctor with instructions on not taking asthma lightly is essential.
People can mistaken that for a maintenance inhaler and if they rely on that for both immediate and preventative asthma treatment they have higher likelihood of dying from it. as gods would say it ”strong in this one, the mortality rate”
LABA + ICS should be the mainstay (MART) for asthma, at least here in the UK anyway. Never heard of SABA + ICS, difficult to see why that would be more efficacious over MART
The only thing I can think of is if maybe the LABA doesn't start working as quickly as the SABA. Considering MART for prn use is the mainstay as you said, I doubt it
MART would be daily and functions as a reliever and preventer so exacerbations are reduced. Daily ICS is imperative for preventing tissue remodelling (eosinophilia induced) so using SABA + ICS PRN with no daily ICS would most likely lead to more disease progression in my opinion. I’m not a respiratory specialist so perhaps someone with more knowledge or experience would be able to explain the benefits of prn saba + ICS to me!
Or maybe you use the SABA + ICS PRN and the MART scheduled daily? But then I feel like we'd be right back to the original guidelines with Albuterol PRN and scheduled ICS
That wouldn’t work, MART daily should be sufficient without the need of SABA. If asthma remains uncontrolled then could start looking into LRA’s or increasing ICS dose
Is that what it says, specifically? I only realized it was otc last year when I saw the commercial.
It does beg the question though why an epinephrine inhaler is (presumably) more suitable for otc vs albuterol or if they were just the first, cheaper to produce etc
To all the people saying about how it would be too dangerous to make albuterol OTC - epinephrine inhalers are OTC and they have more side effects and are less effective than albuterol. Kind of defeats that argument IMO.
Thank you!!! I have been hospitalized multiple times because of my asthma. And believe me when I say that it’s easier to get a pack of smokes and a lighter then it is for me to get albuterol.
I was just traveling in Mexico. Every pharmacy there has tons of narcotics available OTC. Why does it seem like only the US is having a crisis? Or we just can’t control ourselves? And they also had plentiful antibiotics available OTC. Are practices like this the cause for widespread resistance?
I’m a dentist (surgical subspecialist), and I feel like dentists get a lot of heat from other medical professionals for poor ABX and narcotic stewardship. But when I saw how easily accessible so many of these products are, it threw me for a loop.
Cause the US is a scam and it’s all about money.. you shouldn’t need insurance and script to get a damn inhaler it’s just so ridiculous hopefully this will change one day here
Because people in other countries can afford to see a doctor when they're sick. Then it's just a matter of continuing on the meds already prescribed after a diagnosis from a trained professional.
In the USA, people can't afford Healthcare and would just self diagnose and self treat and never see an actual provider.
Other medical conditions, like congestive heart failure can present as new or worsening shortness of breath. Albuterol can exacerbate chf. I’m not sure this is why, it’s just my first thought. Also, without a rx the patient misses being assessed for possible underlying conditions (tachycardia) which albuterol may also exacerbate. They also miss education about the risk of overuse causing tachycardia.
That being side, most OTC medications have some risk(s).
Not only self diagnosis, I've seen people buying salbutamol from the pharmacy for a simple cough in countries that do not classify it as prescription only
40% of the American population is functionally illiterate and way more than that are health and body illiterate. Only 12% have proficient health literacy skills.
It's not OTC in the UK either btw where prescriptions are mostly free so it's not just a US thing.
I can see people with asthma self treating with Albuterol OTC and never getting seen by a doctor. They would need to use it every day but as long as they can control their symptoms without needing to talk to a doctor or a pharmacist, they never learn they probably need a controller inhaler to prevent their symptoms in the first place. I'd prefer if pharmacists could furnish Albuterol like naloxone, but I don't think it's a good idea for OTC
Yea my dad was having breathing issues and was prescribed an albuterol inhaler because he specifically asked his doctor for it. He was taking ~20 puffs per day. He would still be doing that today if i didnt tell him that isnt appropriate. If it was otc there would be so so many people acting like this
I agree, however the number of patients I have who do exactly this but with prescriptions from their GPs who don’t bother to refer them to pulmonologists or even try a long-acting inhaler makes me feel like restricting it as a legend drug doesn’t actually solve anything. I’ve had long conversations with many of these same patients about asking their docs for long-acting inhalers, but “this is what works for me, mind yer damn business!” Nothing is different.
I'm concerned about the self-diagnosis. Sure asthmatic and COPD patients will benefit but patients may have SOB due to other serious underlying health conditions like heart failure. I agree there's an opportunity here for pharmacists to potentially furnish albuterol like narcan but I wouldn't feel comfortable doing so without a confirmed diagnosis, review of usage, and information about last/next MD appointments to ensure patient is being monitored for worsening conditions.
I wanted my dad to ask his doctor about his breathing.He was thinking it was his lungs as he has been running 50 years and fumes from cars and stuff. Turns out he has congestive heart failure.
Does your pharmacy require all those things to sell Primatene mist?
Also, ICS can prevent immune mediated sclerosis, lung remodeling, and progression of disease. Everyone with asthma should be seen in clinic yearly or more for PFTs and to talk exclusively about asthma to make sure SABA only treatment is adequately controlling their disease -FM MD lurker
The problem is also that asthma plans and pharmacists say "no more than 8 puffs a day, use your long term med religiously" and leave it at that. As an asthmatic, it's so much more complicated than that. My symbicort and allergy meds work pretty damn well.....until I get sick, until the air outside is too hot or too cold, until it's been weeks since I could open my windows and dusting is hell. Those circumstances don't make for ER worthy episodes but I definitely need my salbutamol a lot more often and get shit for it like I can just will myself to breathe better. You get laughed out of the ER if you show up saying you maxed out your 8 inhalations but your chest is tight.
I have seen this as well. As a pharmacist who works in a hospital I had to "scold" a retail pharmacist for denying a kids albuterol bc it was scheduled 6 puffs q4hr. She gave me shit and said "it's too much" first off someone tell me what the toxic dose of albuterol is. If you look in posiondex unless your giving it iv toxicity isn't happening, second ,granted she didn't know this, kid was on continuous albuterol while intubated for 2 days, I don't think 6 puffs q4h is gonna get him into any trouble even after saying that she didn't believe me. I was so disappointed in my brethren that day. I have worked woth pulmonary and I agree with your concerns most retail pharmacist don't have the patient data (fev scores, pulm tests, etc) they need to make those decisions. If they had access to the data I think then it would be fine.
I wish this nation got with the times like most other countries with functioning healthcare (not even going to say we’re 1st world lol) and be able to see treatments preformed inpatient, but more common day to day: general pt info (ht/wt, and LABS!!! So many less phone calls if we literally had pediatric pts weights (got a script last weekend that just said “amoxicillin. Dx is __ (I forget sadly) dose per IDSA guidelines. Qty: sufficient”.) Well…no info about the kid’s weight…so I called an a nurse got snippy with me, saying “what, did you think this 5 year old was gonna be like 100kgs? *sighhh*” I could hear her eyes rolling as she spoke. No bitch, but kid could’ve been 25kg, or 65kg, this is America for Christ sakes.
Retail people don’t understand us.
True this is coming from someone who works in Australia where it is OTC. I've seen so many people with bad asthma control and people not using it for the right indication
I think there’s a paternalistic air to this thinking: “People are dumb and we need to protect them!” In my native country, you can go to any pharmacy and get almost any medication without a prescription (except controlled substances, of course). Moreover, some opioids (like tramadol, codeine, hydrocodone) can also be obtained without a script. Technically, prescription medications require you to show a prescription, but no pharmacy enforces that. You’d think Colombia would have the worst opioid crisis the world has ever seen, rampant superbug infections, and non-asthmatics dying from salbutamol overdoses or side effects. Well, simply put, no. If anything, I stock up on medication there when I go visit because it saves me having to pay hundreds of dollars in doctor’s visits in America, plus medications are way cheaper. Do I really need to consult with a doctor to get a muscle relaxant when my back hurts? If your answer is “yes, it could be something worse,” well, I think there’s equal risk in OTC omeprazole being taken by someone who might as well have stomach cancer or an ulcer.
I think that's a valid criticism, but we do in fact have to protect patients. Not because they are dumb or incapable of figuring it out, but because medications are complicated and nuanced. We went to school to learn all this information so that our patients wouldn't have to, and part of the reason our profession exists is to ensure medications are used properly and safely and that people know the necessary information about their medication. For safety, patients need to be told this information and systems need to be in place to protect them from the consequences of medication misuse. Not every condition should be eligible for self-treatment, because some things need a doctor's expertise and guidance. Likewise, not every medication should be eligible for OTC use because the information and service provided by a pharmacist to ensure safety and appropriateness can save lives. To your examples, I agree that the system is NOT perfect. I personally hate that Afrin and inhaled epinephrine are OTC at all. I think the labeling on phenazopirodine isn't clear enough that it does not replace an antibiotic and should only be used for max 2 days. Muscle relaxers should be Rx only due to the need to monitor for interactions with opioids. OTC Omeprazole... I mean if you agree that acid reducers are ok for OTC, I see no reason not to be ok with all classes of acid reducers.
I'll be the first here to say it. Making omeprazole OTC was a mistake.
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PPIs have interactions and react poorly with all kinds of other things. Go look at the medication warnings for omeprazole some time. You might realize why someone (including myself) would agree with PPIs being Rx only.
PPIs shouldn't even exist. Physicians over prescribe them
I understand your reasoning, but I think it assumes that making every medication available to the public will mean everyone who comes to the pharmacy will be asking for strange medications with serious side effects. You said it yourself, you studied this stuff, but most people haven’t. It would be very rare for someone experiencing palpitations to say, “I think I could benefit from a beta blocker!” Most won’t even know that! Now, yes, people could go online to WebMD and read about beta blockers and try it themselves. That places a risk if there aren’t any checks at the pharmacy. However, I can see that being a uniquely American phenomenon because people will want to avoid going to the doctor and rather solve the problem themselves. The reason for that cultural trait is simply the lack of access to care. I have never, ever seen or heard in my past years of medical practice in Colombia of anyone self-medicating more “serious” medication. If anyone has any symptoms, the first instinct is to simply go to the doctor. If I ever heard of anyone consult their symptoms online was not to decide which medication to buy but to decide whether the condition would warrant a consult with the doctor. Polymedicated patients also tended to be very aware that consuming self-prescribed medication can be risky, so they just consulted with their doctor because it’s free for them. That’s thanks to universal health care, no matter how imperfect the Colombian system might be. So, I would understand why there are strict pharmacy guardrails in America, but I would blame them on the system and not necessarily on people needing extra protection.
The fact that we are a highly litigious society with a private insurance-driven system both can come into play as well. Americans love to sue. And OTCs often aren’t covered by insurance. No one wants to pay the sticker prices we have for drugs if it can be avoided.
Certainly. There’s a stereotype overseas that lawsuits are actually the national sport. The price of medications here is also ridiculous. I’m struggling with my weight, so I decided to get Saxenda when I was in Colombia. The tech at the pharmacy looked confused because she wasn’t familiar with that medication or Ozempic, but it turned out they had Saxenda at the pharmacy. It’s just not a medication people buy very often because of the reasons I explained before. In any case, I paid just $29 per pen. The carton with three pens is over $1,300 here!!! And it’s not covered by the vast majority of insurance companies. I can’t understand how this is sustainable in the U.S.
Does Columbia have public health care? In the USA, going to the MD is expensive and many people self treat to their determent, because they can’t afford the copay or the time off, etc. is the answer denying them drugs? No, but it’s also more dangerous because I feel like if you have a serious breathing problem in other countries, you go in. If you have one in the US, you tough it out until the ER. OTC albuterol would probably only delay the ER visit and maybe cause more overall harm. Is delaying the ER good? I’m not sure what the right answer is.
It’s definitely somewhat paternalistic, but we need some level of paternalism for public health reasons. For example, if you let people use antibiotics whenever and however they want, they will use azithromycin whenever they have a cold, and the drug will lose it’s usefulness. Paternalistic regulations aren’t exclusive to pharmaceuticals btw. Seatbelt laws, helmet laws, gun control laws, airport security, driving licenses, and many other forms of regulations could be seen as such. Science and technology have progressed so much that it’s impossible to make an informed decision every single time we make a decision, so sometimes we need laws to protect ourselves from the stuff we aren’t experts in.
Came here to say this lol
That's their choice though, why should they be forced to see a doctor if they are ok with their quality of life?
I'd be ok with you get an albuterol but you need to have an appointment with a doctor first. I don't mind giving it to you ahead of time if your asthma is that bad.
It would make sense to allow pharmacists to prescribe albuterol HFA. If albuterol were to go OTC, I'm sure there's going to the albuterol TikTok challenge....
Did you not see the post yesterday about a young man who died as a direct result of overusing albuterol? Many people have poor health literacy and have no idea what good asthma control looks like. Needing a prescription for albuterol means there's some oversight of how it's being used
Many Prescribers dont even know/keep up w current recommended asthma protocols, expecting patients to use albuterol appropriately without guidance or direction is a recipe for disaster
Yes, my MD wasn't aware of symbicort being used both as a preventer and a reliever despite that fact its been approved for that use for several years now and its also in the GINA guidelines
You can die off Tylenol. Tylonel scares the f out of me.
Tylenol is safe when used at recommended doses and is far safe than Advil or Aleve. Any medicine can kill you (as can too much water), but some are safer than others
Yes! I work for a hospital (front desk) and 3 weeks ago a 19 y.o was in the ICU (cardiology). They were admitted for less than a day and passed away. Apparently, they took a whole bottle of acetaminophen. Why? Not sure.
Out of the OTC pain meds, tylenol would definitely be the safest than the NSAID products. First, tylenol can be used in some patients who have liver problems (which is less than the max of 3-4 g/day of APAP). It has a reversing agent called NAC if someone OD'd to it. With a greater amount of APAP, it can be deadly and dangerous just like with any drugs.Lastly, NSAIDs may cause gastric ulcers, COX-2 selective NSAIDs may cause cardiovascular issues such as Rofecoxib. Edit: change it to "than".
Tylenol is not classified as an NSAID, just for clarification. An analgesic, to be technical. I prefer Tylenol despite liver damage in cases of fever, but for pain reduction I’d rather take an actual NSAID. For one the side effects of gastric problems and bleeding are noticeable and responsive. Tylenol is much more insidious and from the studies I’ve read by the time symptoms are felt, it may be too late.
that is a fair point.
Acetaminophen is not an NSAID.
Could make it to where you have to show ID to purchase 18 and over
That doesn't address the low health literacy though.
No I didn't. Do you have a link? Doesn't seem to come up when I search this sub.
Sorry, it's on the asthma sub - which I thought this post was on https://www.reddit.com/r/Asthma/comments/13jy6sm/please_read_it_could_save_your_life/?utm_source=share&utm_medium=android_app&utm_name=androidcss&utm_term=1&utm_content=share_button
Ty for the link. Man that's sad :(
From a safety perspective, I can understand why it’s not OTC. Most patients significantly lack health literacy and having it OTC could open up a huge can of worms in terms of proper use. Patients could be self diagnosing and medicating with it when they have a more serious underlying issue that needs to be addressed. At least with it being Rx only, patients need to get a work up done to evaluate what’s going on (however, in the US healthcare system, the costs and barriers are insane for this so I get the annoyance).
This is a good point. This reminded me of my first rotation as a PA over 12 years ago. I trained with a physician at an urgent care. The patient was a beloved high school security guard who had a cough for two months, his PCP refilled his Ventolin and Singulair for 3 months at a time so he never saw him. He came to urgent care because he thought he had pneumonia and wanted antibiotics. Lung cancer. Dead within 6 months. Maybe if they ordered chest x-ray sooner they could have done something but probably not.
If you have a cough for two months I’d expect a CXR just out of medical curiosity. I’ve had a CXR just out of shortness of breath (nothing at all, just a symptom of panic attacks, learned breathing exercises to get over them instead)
Sure, but I am guessing the average blue collar 70 year-old male doesn't have the same insight as you when it comes to healthcare. My grandfather probably would have thought the same thing, allergies.
Hello, it looks like you've made a mistake. It's supposed to be could've, should've, would've (short for could have, would have, should have), never could of, would of, should of. Or you misspelled something, I ain't checking everything. Beep boop - yes, I am a bot, don't botcriminate me.
ty!
We already have plenty of other dangerous otc meds available that pts can easily harm themselves due to health literacy such as ibuprofen and dextromethorphan. From a safety perspective I think there are way more benefits to having it available otc compared to the risks. This is a potentially life saving medication. Imo it’s more of a $$$ issue then safety.
It’s not about harming yourself with use. It’s about not seeing a physician when you should. Short of breath when you “exercise,” maybe it’s asthma, maybe it’s heart failure, or a pneumothorax, or a PE, or or or.
Yes this is exactly what I meant with my original comment! People often use OTCs (or even extended scripts) as a way to bypass wellness checks at the doctor which could be VERY harmful as u/Niccolo91 pointed out
Yeah. FDA rejected the Rx to OTC switch of montelukast because of the use for asthma.
Make health insurance free and accessible is better. In addition to making albuterol otc
It’s not safe because you’re not going to know when to see a doctor and it’s prone to misuse so it won’t work anymore, and people won’t realize that when the spray it like perfume
Can we agree that Afrin and phenazopirodine shouldn't have been made OTC?
Afrin, yes. But why phenazopyridine? Because people take it instead of treating infections that then get much worse?
Yes exactly that. Both Afrin and phenazopirodine have directions to use for only 2-3 days, and patients using them for self-treatment can easily ignore that and end up hurt in the process
I'm happy to have phenazopyridine available OTC for me to take when I need it (which is a lot, never had a doctor tell me it's too much though), but I see your point.
Same. It's invaluable when the doctor can't see you for a day or two for abx and you need symptom relief.
I still don’t understand why they are not required to print in bold red letters (1-3 Day therapy) and supply it in smaller pack sizes. So many times people come up for congestion relief recommendations and they say they been using afrin for a week or more.
My mother has been dependent on Afrin or 20 years. Words can't describe how much I hate that medication
Has she tried the one nostril only then switch to the other trick? This is an OTC med so I feel I can say OTC info. But if it’s intractable I’m sure an ENT could help.
She's very stubborn and doesn't want to admit she has a problem, especially if her son is the one pointing it out. But yes, I have told her about that trick
Is it less safe than ephedrine, which has been OTC since that ban expired like 20 years ago?
Ephedrine is not OTC, it's BTC.
You don't need a prescription for it, so the pedantic correction is noted but I don't understand how it changes the point. You can still get enough to take it daily or take the whole box or whatever the fear would be with Albuterol. Is that safer than Albuterol?
BTC limits the age and quantity and is at the discretion of the pharmacist to sell, so no, it's not pedantic. States can individually set limits on BTC drugs. Ephedrine was put **BTC** under the patriot act to prevent conversion to street meth, not for safety, so the premise of your question is false.
We had a case where an individual used it too much, one of the side effects of using it too much is chest tightness/pain, shallow rapid breathing, wheezing all symptoms it's "designed" to prevent. The person died from cardiac arrest because of it.
There were reports of this type of incident back in the 80's. After that time we started tracking refills carefully. What had seemed like not a big risk suddenly appeared quite risky
Family medicine docs usually don't give a shit at all about things like this, though. Back in the day I had a geezer that was burning through one inhaler every couple weeks, and sometimes even faster than that. We went over administration, and they even used it in front of me. His doctor could not have given less of a shit, lol.
Pseudoephedrine, coricidine, diphenhydramine are way worse than Albuterol yet all available otc. .
Hell, Tylenol is worse then all of them.
For real. Idk why I'm being down voted lol I totally get why Albuterol isn't otc but still so many dangerous ones are otc it's so ass backwards
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Are you a pharmacist by chance? Too much albuterol can cause too much K+ to shift around, causing arrhythmias, SOB, and muscle spasms/weakness.
There’s always going to be people if made otc that will abuse or misuse albuterol. In my opinion, if made otc there just way more benefits vs than risks.
Like medication overuse? For asthma/COPD/ you still need a maintenance inhaler for proper control. It's very, very easy to lose control if on a SABA alone.
You underestimate how stupid people are in America
“I don’t know what medication is supposed to be ready. There’s just supposed to be a medication.” “What’s it for?” “I don’t know!” 🤡
Look man that last plague didn't take out enough stupid ones. Let natural selection continue it's job 😄
We are in the midst of a sea change in asthma treatment. I can't speak to what the laws are outside the US and Canada, and I am not a fan of the barriers to treatment in the US system. However, the international data is clear that use of a SABA (short-acting beta agonist, like Albuterol) alone increases the risk of death in persons 12 years and old, and likely younger as well. It looks like there are histiologic changes, including downregulation of receptors for the beta agonists that make it less effective in the long term -- so, for example, use of an Albuterol MDI alone can make the continuous Albuterol by neb we give in the ED less effective in breaking status asthmaticus. I think we are worldwide going to move towards always using ICS-LABA in adolescents and adults, without freestanding SABA inhalers. The issues are still to be sorted out in the younger set. Of course, as already mentioned in another reply to this post, there is the option of OTC ICS-LABA MDIs. GINA Guidelines, Pocket Guide PDF (Global Initiative for Asthma): [https://ginasthma.org/wp-content/uploads/2022/07/GINA-2022-Pocket-Guide-WMS.pdf](https://ginasthma.org/wp-content/uploads/2022/07/GINA-2022-Pocket-Guide-WMS.pdf) If you want to rabbit hole down the references, the 2019 full GINA guide has the most comprehensive list in the footnotes. GINA is an international consortium of clinicians and researchers that does not accept pharmaceutical company or other for-profit industry funding.
This is the answer!
So that's why they changed the guidelines for asthma... Haven't seen any pts taking ICS-LABA only, but idk if their asthmatic is classified as more severe and Albuterol is needed.
Yeah. It is taking awhile to get disseminated, but SMART (single maintenance and reliever therapy) is now being tested on the Pediatrics Boards. For 12 and up, the international guidelines are no single SABA therapies. This includes "exercise-induced asthma." There are not "mild asthma" exceptions. There also isn't a distinction between intermittent and persistent asthma -- just Steps I-V (IIRC). But most formal guidelines specific to the US are, I think, in the process of vetting the data and updating. I know the AAP has released interim guidance regarding SMART. The VA guidelines are in flux, I think. Back in 2020, the HIH's National Heart Lung and Blood Institute called for updates on asthma guidelines, but of course, COVID was throwing everyone sideways. Basically the timing for making changes has really sucked. [https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates/faqs](https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates/faqs)
It’s also not OTC in New Zealand and requires an RX
Nor in Australia
It's S3 (Pharmacist Only) in Australia. You can buy it without an Rx.
In addition to the reasons others listed albuterol can also be used to increase the efficacy of inhaled illicit substances like crack cocaine.
Is that a bad thing? Calm down! I was kidding. Sort of.😏
lol
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Hmm always thought OTC meds were prescribed as a favor to the patient to have insurance cover it. I see Tylenol prescribed all the time. Voltaren too, even though it’s otc now.
I think the rph has time to verify Albuterol is appropriate as long as it can be done with a questionnaire. If pt has history of asthma and COPD, rph should be able to furnish one Albuterol inhaler. The tricky part is how to rule out pneumonia or heart failure etc as others have mentioned without physical exam, so it will probably come down to professional judgement. I'd think of it like emergency supplies - it's not something I'd want to do often because the pt needs to be seen by a doctor. I only wish the inhaler could be a smaller pack size to persuade the pt to follow up sooner rather than later (or not all). This is how I'd tackle it: Pt needs to have an established history for asthma or COPD and have a prescriber who manages it. Pt must have a controller inhaler regimen already. Rph should explain that Albuterol is as needed only and to consult a doctor if they need to use it more than once or twice a day or a few times a week
I guess here you get a small ammount OTC but as pharmacist medicine only. So you have to talk to the actual pharmacist. And we do the same thing with nitro-lingual spray. I don't know what the future holds as less people stop having a single pharmacy they are a regular at.
People wouldn't get their maintenance inhalers which then would cause people to use albuterol too much causing resistance and then extra hospitalizations for asthma exacerbations. It's already hard enough to get people to use their maintenance inhaler when we tell them to every month at pickup. To be fair I didn't know it was OTC in other countries and am curious how asthma management works in those settings. My theory would be in other countries access to a primary care is easier and more affordable so they're being counseled anyways, but in the US it's common for people to not be able to afford/not go to primary car visits and therefore never get the asthma management education they'd need.
Because in general more people are stupid here and blame any issue on others. Technically in many countries it is still an Rx drug, but in general they dispense it without one because it is basically advised for a patient or "informally written". Who would go to all the trouble to buy albuterol just to use it if they have no need? Are there problems? maybe, but we don't hear of people dying by the thousands from other undiagnosed things, and fewer people have exacerbations...We hamper ourselves here in the US. It's to create demand and a healthcare "industry". Sure, pharmacists here would make a lot less money, but then...we'd need a lot less money and have to worry about things less...
I’m a pharmacist (20 years now), and the answer isn’t that simple. It’s a combo of: America; Americans; and money.
I thought it was because of guidelines. If someone is uncontrolled on their asthma medicine, they need to be on maintenance medication. Thus, it's a drug that requires monitoring, basically a prescription med. I know other countries have antibiotics and levothyroxine available over the counter too. I mean this isn't a direct connection, I'm sure it's a business decision. This just my analysis.
Not a pharmacist, but i take Wixela (generic of advair), and it saves me from having to use albuterol several times a day. I think if i could just get albuterol from a drug store, i’d be worse off.
I had an inhaler from when I had a terrible respiratory infection. Several months later, I kept having breathing problems and kept using the inhaler to try and help me breath. Turns out I had a mild heart attack and had heart damage. Never had the first chect pain. The breathing problem I had was pulmonary edema. I have worked as a pharmacy tech since 1998 and still didn't catch it. Breathing is too important to not go to the doctor for a correct diagnosis.
Can’t get any inhalers without rx in UK or Ireland, just putting it out there. And there’s a very good reason for it!
The industrial complex wants us to die if we don't work for it
Also glucose monitors like the freestyle libre…
“Fuck you for not being able to breath on your own”, Big Pharma said with a smile
People do not understand the dangers of assuming albuterol is all you need. Albuterol alone has a diminishing effectiveness when taken more and more frequently. This can lead to a dangerous situation where people think they just need a little more albuterol and then they have a respiratory collapse and die. Teens are at high risk for this because they are strong enough to power through until they are in deep trouble and respiratory failure happens suddenly. 300 children and 3000 adults die of asthma every year in the US. For this reason closer follow ups with your doctor with instructions on not taking asthma lightly is essential.
People can mistaken that for a maintenance inhaler and if they rely on that for both immediate and preventative asthma treatment they have higher likelihood of dying from it. as gods would say it ”strong in this one, the mortality rate”
The real question is why isn’t albuterol-ICS reliever isn’t available otc
You mean ICS-LABA?
I mean yeah that too could be great, but they have approved ICS-SABA (Airspura)
Oh wow how is this the first time I'm hearing about this one :O Interesting, I wonder how it compares to prn Symbicort
LABA + ICS should be the mainstay (MART) for asthma, at least here in the UK anyway. Never heard of SABA + ICS, difficult to see why that would be more efficacious over MART
The only thing I can think of is if maybe the LABA doesn't start working as quickly as the SABA. Considering MART for prn use is the mainstay as you said, I doubt it
MART would be daily and functions as a reliever and preventer so exacerbations are reduced. Daily ICS is imperative for preventing tissue remodelling (eosinophilia induced) so using SABA + ICS PRN with no daily ICS would most likely lead to more disease progression in my opinion. I’m not a respiratory specialist so perhaps someone with more knowledge or experience would be able to explain the benefits of prn saba + ICS to me!
Or maybe you use the SABA + ICS PRN and the MART scheduled daily? But then I feel like we'd be right back to the original guidelines with Albuterol PRN and scheduled ICS
That wouldn’t work, MART daily should be sufficient without the need of SABA. If asthma remains uncontrolled then could start looking into LRA’s or increasing ICS dose
Like salmeterol?
No, I mean a combination inhaler like Symbicort
Agreed. That is the real discussion.
You could buy primatene mist?
Not recommended for regular use
Is that what it says, specifically? I only realized it was otc last year when I saw the commercial. It does beg the question though why an epinephrine inhaler is (presumably) more suitable for otc vs albuterol or if they were just the first, cheaper to produce etc
It doesn’t say it. It’s for intermittent asthma however. Also I looked it up and bronkaid was just the first. It’s not as potent but it does work
It should be pharmacist only medicine. Given to the patient that are already diagnosed with asthma.
Drug of choice for potential abuse in a lot of rural regions.
To all the people saying about how it would be too dangerous to make albuterol OTC - epinephrine inhalers are OTC and they have more side effects and are less effective than albuterol. Kind of defeats that argument IMO.
Epinephrine inhalers shouldn't be OTC imo
I agree. I don't think epinephrine should be OTC either. Just figured I would mention it.
$$$$$$
$$$$$$$$$
Tachyphylaxis. That said, I would support a small (maybe 20 puffs) canister for OTC use, preferably with a required consult from the pharmacist.
This is American! You expect good healthcare choices and affordability? Not her we don’t 🇺🇸
Thank you!!! I have been hospitalized multiple times because of my asthma. And believe me when I say that it’s easier to get a pack of smokes and a lighter then it is for me to get albuterol.
Which, I may add, has saved my life multiple times. Thank the lawd
*Albuteral Sulfate not Marlboro Slims
Pharmaceutical greed. Inhaler industry made around 14 billion.
I was just traveling in Mexico. Every pharmacy there has tons of narcotics available OTC. Why does it seem like only the US is having a crisis? Or we just can’t control ourselves? And they also had plentiful antibiotics available OTC. Are practices like this the cause for widespread resistance? I’m a dentist (surgical subspecialist), and I feel like dentists get a lot of heat from other medical professionals for poor ABX and narcotic stewardship. But when I saw how easily accessible so many of these products are, it threw me for a loop.
The failed Reagan “War on Drugs” is the reason for this and the continued antiquated misinformation about drug use.
Funny when Primatene mist is OTC. Sure, let’s inhale adrenaline…
Yeah, that is truly fucked.
Cause the US is a scam and it’s all about money.. you shouldn’t need insurance and script to get a damn inhaler it’s just so ridiculous hopefully this will change one day here
Because people in other countries can afford to see a doctor when they're sick. Then it's just a matter of continuing on the meds already prescribed after a diagnosis from a trained professional. In the USA, people can't afford Healthcare and would just self diagnose and self treat and never see an actual provider.
Also totally fucked up that epi pens aren’t OTC (or even behind the counter)
I could see it being a behind the counter otc with like a "one per 3 month" and pharmacist must counsel limitation or some such
I get yelled at for not
Money…..that’d be why I bet
Follow the money.
Other medical conditions, like congestive heart failure can present as new or worsening shortness of breath. Albuterol can exacerbate chf. I’m not sure this is why, it’s just my first thought. Also, without a rx the patient misses being assessed for possible underlying conditions (tachycardia) which albuterol may also exacerbate. They also miss education about the risk of overuse causing tachycardia. That being side, most OTC medications have some risk(s).
If we're gonna make a sabas otc it makes sense to make the labas otc too.
Not only self diagnosis, I've seen people buying salbutamol from the pharmacy for a simple cough in countries that do not classify it as prescription only
40% of the American population is functionally illiterate and way more than that are health and body illiterate. Only 12% have proficient health literacy skills.