Can I Use an Over-the-Counter Inhaler for COPD?

Woman using an inhaler for COPD

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If you have chronic obstructive pulmonary disease (COPD) you may be wondering if you can substitute an over-the-counter (OTC) inhaler for the short-acting bronchodilator your doctor prescribed.

Primatene Mist (epinephrine inhalation aerosol), the only OTC inhaler available in the United States, is approved by the U.S. Food & Drug Administration as a treatment for acute asthma symptoms, but not COPD.

Still, some people with COPD find an OTC inhaler helpful in a pinch. For instance, if you are traveling and did not bring your rescue inhaler, using Primatene Mist may help to ease breathing difficulty. However, epinephrine is not recommended as a substitute for albuterol.

OTC vs. Prescription Inhalers

Short-acting bronchodilators are used as a rescue inhaler to treat acute COPD symptoms of dyspnea (shortness of breath), chest tightness, wheezing, and coughing spells.

Prescription rescue inhalers deliver a class of drugs known as short-acting beta 2-agonists (SABAs). They work by binding to the beta 2-adrenergic receptor, which signals the smooth muscle tissue of the lungs to relax. As a result, the bronchi and bronchioles of the lungs dilate, relieving bronchospasms that cause chest tightness and coughing during a COPD flareup.

Prescription SABAs are the gold standard for treating acute COPD exacerbations and include:

  • Proventil HFA, Ventolin HFA, ProAir HFA (albuterol)
  • Xopenex HFA (levalbuterol)
  • Alupent (metaproterenol)
  • Maxair (pirbuterol)

The OTC inhaler Primatene Mist contains epinephrine, the drug form of the hormone adrenaline that is commonly used to treat allergic reactions. Epinephrine is both an alpha- and beta-adrenergic agonist and works in a similar way as SABAs to relax and open the air passages in the lungs to make breathing easier.

In 2011, Primatene Mist was pulled from the market due to its use of chlorofluorocarbons (CFCs) as a propellant, which were banned for environmental reasons. After reformulating to use hydrofluoroalkanes (HFAs) instead, Primatene Mist returned to drug store shelves in 2018.

Primatene Mist is FDA approved for the temporary relief of symptoms of mild, intermittent asthma and should not be used as a replacement for prescription inhalers. It is not approved for the treatment of COPD and while it may provide temporary symptom relief, it is not recommended.

Risks and Considerations

Primatene Mist is not recommended for the treatment of COPD exacerbations, according to the 2020 Global Initiative for Obstructive Lung Disease (GOLD) report.

Using an over-the-counter breathing treatment for COPD raises a number of concerns and you should not use one without first consulting with your doctor. A progressive lung illness, COPD should be managed by a medical professional. If you are reaching for an OTC inhaler, that may be a sign your COPD is not well controlled on your current medication regimen.

Short-acting bronchodilators are the first-line inhalers for COPD, but as the disease progresses may not be enough to control symptoms long-term. Using an OTC inhaler may mask a worsening of your condition and delay getting appropriate medical care.

If you are unable to manage your COPD on prescription rescue inhalers alone, your doctor will likely prescribe a long-acting beta-agonist (LABA) such as Serevent (salmeterol), a long-acting anticholinergic/antimuscarinic antagonist (LAMA) such as Spiriva (tiotropium bromide), or combination inhaler such as Stiolto Respimat (tiotropium/olodaterol) for long-term symptom management and prevention of exacerbations.

The 2020 Global Initiative for Asthma (GINA) guidelines recommend that anyone with COPD who experiences shortness of breath or exercise intolerance should be treated with both a LAMA and LABA, rather than either inhaler alone. These drugs are only available by prescription.

In addition, taking OTC epinephrine alongside other short-acting bronchodilators may cause unpleasant side effects. Though not contraindicated for combined use, both epinephrine and albuterol-type medications can increase your heart rate and cause nervousness and tremors. Combining medications can increase this effect.

If you are having difficulty breathing and your symptoms do not improve within 20 minutes or continue to worsen after using Primatene Mist, or if you experience chest pain, seek immediate medical help.

Non-Prescription Options for Better COPD Management

If you have COPD and are reaching for an OTC inhaler because you are struggling to manage symptoms using the medications prescribed, there are a few non-drug ways to improve your condition.

Lose Weight: Carrying excess pounds can make breathing more difficult, so losing weight if you are overweight can help improve your symptoms. Even if you don't need to lose weight, getting regular exercise—even something as simple as walking around the block—can help to improve lung function.

Eat Right: Avoid processed foods, junk food, and meats cured with nitrates, which are shown to exacerbate COPD symptoms. Instead, aim for healthy whole foods with lots of fruits and vegetables.

Avoid Triggers: Identifying and avoiding anything that aggravates your lungs can also help to prevent a flare-up of COPD symptoms. While COPD triggers are different for everyone, some common triggers include cigarette smoke, dust, air pollution, extreme weather (hot, cold, or humid), and other illnesses. If you need help quitting smoking talk to your doctor.

Stay Healthy: People with COPD are more prone to severe upper respiratory infections that lead to exacerbations of breathing problems. Prevent catching contagious illnesses by staying up to date on your vaccinations, washing your hands frequently, avoiding people who sick, and wearing a mask in indoor public places during periods of influenza or COVID-19 outbreaks in your area.

If You Can’t Afford Your Prescriptions

The high cost of prescription medications can lead some people with COPD to substitute with OTC inhalers. If you are struggling to pay for the medications your doctor prescribed, there are a few things you can do.

If you have prescription drug insurance, call to find out the preferred medications for treating COPD. These will typically have a reduced copay compared to medications in a higher tier on the prescription drug formulary. Your doctor may be able to switch you to a similar medication with a lower out of pocket cost to you.

In addition, the patents on several COPD medications have expired in recent years, opening the market to lower-priced generic drugs that your doctor can prescribe instead. These include:

  • Short-acting bronchodilators: Ventolin, Xopenex, and Proair
  • Combination LABA and corticosteroids: AirDuo (fluticasone/salmeterol), which is comparable to Advair Diskus
  • Inhaled corticosteroids: Pulmicort (budesonide)

Many pharmacies and drug companies also offer coupons that can save you money on your medications with prescription discount cards, such as GoodRx or RxSaver. The following COPD drug manufactures offer programs that can help offset the cost of treatment:

  • AstraZeneca has prescription discount programs for eligible patients for the drugs Pulmicort and Symbicort (budesonide/formoterol).
  • GlaxoSmithKline offers assistance to patients without insurance or with Medicare Part D for Advair (fluticasone propionate), Breo Elipta (fluticasone/vilanterol), Flovent (fluticasone propionate), and Serevent (salmeterol).
  • Merck has a program that provides medications free of charge to eligible patients including Asmanex (mometasone), Dulera (mometasone/formoterol), and Proventil.
  • TEVA Pharmaceuticals provides discounts for eligible patients through the TEVA Cares Foundation for both ProAir and QVAR (beclomethasone dipropionate).
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