Over-The-Counter Asthma Inhalers

With the high cost of prescription inhalers, you may wonder whether over-the-counter asthma inhaler medications are available in the United States. Asthmanefrin (racepinephrine) is a currently available nonprescription OTC inhaler medication.

These types of asthma medications are designed for the temporary relief of asthma symptoms such as shortness of breath, chest tightness, and wheezing. Before you decide to use an OTC asthma inhaler, see why it may or may not be a good choice.

otc asthma inhaler side effects
​Illustration by Emily Roberts, Verywell

Should You Use an OTC Asthma Inhaler?

How sure are you that your symptoms are asthma? Many patients report using over-the-counter products before getting a diagnosis, despite OTC asthma inhalers not being labeled for this purpose. Classic asthma leads to the following symptoms:

  • Wheezing
  • Chest tightness
  • Cough
  • Shortness of breath

However, these symptoms can be part of other serious diseases as well. An OTC asthma inhaler may provide symptom relief and mask some more serious conditions such as heart disease or COPD. If you are not sure about your symptoms, make sure you get checked out by a healthcare professional.

Additionally, OTC asthma inhalers state in their packaging they are only to be used for temporary relief and the most recently approved OTC asthma med clearly states that you should be diagnosed by a physician with asthma before using.

Asthma is not a minor condition. You may be at risk for a fatal asthma attack. If you have poorly controlled symptoms, an OTC asthma inhaler is probably not for you.

Side Effects of OTC Asthma Inhalers

Just like prescription medications, OTC medications also carry a risk of side effects. Common side effects of OTC asthma inhalers include:

  • Appetite changes
  • Dizziness
  • Headache
  • Hyperactivity
  • Nausea
  • Nervousness
  • Shakiness
  • Sinus pain
  • Sore throat
  • Tremor
  • Trouble sleeping
  • Vomiting

Safety Concerns for OTC Inhalers

Finally, is an OTC asthma inhaler safe? Some healthcare providers do not feel OTC asthma inhalers are safe. They point out that medications for other serious conditions such as diabetes or heart disease are not sold over-the-counter.

The FDA has issued a warning specifically for Asthmanefrin and its EZ Breathe Atomizer. They warned patients that they had received complaints about chest pain, high blood pressure, nausea and vomiting, and spitting up pink or red sputum. Also, a 2014 study found that Asthmanefrin provided less bronchoprotection than albuterol and may be less effective in treating acute bronchospasm.

Chlorofluorocarbons (CFCs) were used before 2011 as the propellant to deliver medication from many OTC asthma inhalers like Primatene Mist and prescription inhalers. CFCs were banned from inhalers by EPA to decrease ozone levels and do less environmental damage. As a result, Primatene Mist was removed from the market but has returned since replacing CFCs with hydrofluoroalkane.

Asthmanefrin OTC Asthma Inhaler

Asthmanefrin (racepinephrine) is a CFC-free asthma product that is currently available for use that acts as a bronchodilator. It relieves asthma symptoms by relaxing inflamed muscles and functionally enlarging the airways of the lung. You should not use Asthmanefrin if you have any of the following conditions:

  • Heart disease
  • High blood pressure
  • Thyroid disease
  • Diabetes
  • Difficulty in urination due to an enlarged prostate gland

Asthmanefrin is a little different because it's not a traditional inhaler. Rather, the EZ Breathe Atomizer takes a small amount of liquid and turns it into a fine mist that can be inhaled into the lung. Once in the lung, it acts as a bronchodilator to improve your symptoms.

The FDA warns that this medication's side effects should be monitored and if you use it, you should report any reactions.

Medical Organizations Opposed to OTC Asthma Inhalers

Not all professionals believe over-the-counter asthma inhalers like Asthmanefrin should be available to consumers. In fact, organizations such as the American College of Asthma, Allergy & Immunology, the American Association for Respiratory Care, the American Thoracic Society and the National Association for Medical Direction of Respiratory Care do not want OTC inhalers to be included in asthma treatment guidelines because they do not feel that over-the-counter epinephrine products are safe for the treatment of asthma.

A Word From Verywell

You will need to decide for yourself if this is an appropriate OTC treatment for you. You might be attracted to the lower cost and that you don't need to get a prescription. But these products are not the same as prescription inhalers. Asthma can be a life-threatening condition, and it needs to be discussed with your healthcare provider. If you have any questions about whether or not it is appropriate, please talk with your doctor.

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Article Sources

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  1. American College of Allergy, Asthma & Immunology. Asthma Symptoms.

  2. U.S. National Library of Medicine DailyMed. Label: Asthmanefrin - racepinephrine hydrochloride solution. Updated October 30, 2019.

  3. U.S. National Library of Medicine ToxNet. HSDB: Epinephrine. Updated January 21, 2010.

  4. U.S. Food and Drug Administration. Class 1 Device Recall EZ Breathe Atomizer. Published May 29, 2013.

  5. Mondal P, Kandala B, Ahrens R, Chesrown SE, Hendeles L. Nonprescription racemic epinephrine for asthma. J Allergy Clin Immunol Pract. 2014;2(5):575-8. doi:10.1016/j.jaip.2014.02.014

  6. Chest Physician. FDA approves Primatene Mist return. Published November 15, 2018.