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

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 healthcare provider prescribed.

Woman using an inhaler while standing outside
Mayur Kakade / Getty Images

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

OTC vs. Prescription Inhalers

There are no OTC medications approved for the treatment of COPD. The condition is managed with a combination of short-acting bronchodilators like albuterol for acute symptoms and long-acting maintenance medications to prevent exacerbations.

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). The OTC inhaler Primatene Mist is also a short-acting bronchodilator. It contains epinephrine, the drug form of the hormone adrenaline that is commonly used to treat allergic reactions.

Epinephrine is not recommended as a substitute for prescription SABAs, which are the gold standard for treating acute COPD exacerbations. These include:

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

Risks and Considerations

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 COPD.

Using an over-the-counter breathing treatment for COPD raises the following concerns and you should not use one without first consulting with your healthcare provider.

Ineffective For COPD

While SABAs and Primatene Mist are short-acting bronchodilators, they are not equal.

SABAs bind to the beta 2-adrenergic receptor, signaling the smooth muscle tissue of the lungs to relax and dilate the bronchi and bronchioles, relieving bronchospasms that cause chest tightness and coughing.

Epinephrine, an alpha- and beta-adrenergic agonist, works similarly to SABAs to make breathing easier, but not as well. Epinephrine may be helpful for treating an asthma attack, however, it does not appear to be effective during a COPD flareup.

Masks Worsening COPD

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. Most people with COPD also need to use long-acting controller medications to prevent symptoms and dangerous flare-ups. Using an OTC inhaler may mask a worsening of your condition and delay getting appropriate medical care.

Prevent Better COPD Control

COPD exacerbations are serious and often require hospitalization. Instead of adding an OTC medication on your own, which is unlikely to be effective and may be dangerous, ask your healthcare provider for an action plan for managing flare-ups. Tell your healthcare provider anytime you experience an exacerbation.

If you are unable to manage your COPD on prescription rescue inhalers alone, your healthcare provider will likely prescribe one of the following for long-term symptom management and prevention of exacerbations:

The 2020 American Thoracic Society Practice 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.

Increased Side Effects

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 continue to have difficulty breathing or experience chest pain, seek immediate medical help.

Non-Drug Ways to Improve COPD Management

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

  • Lose Weight: Carrying excess pounds can make breathing more difficult, so losing weight if you are overweight can help improve your symptoms.
  • Exercise: 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 things that aggravate your lungs can help to prevent a COPD flare-up. While COPD triggers are different for everyone, common triggers include cigarette smoke, dust, air pollution, and extreme weather (hot, cold, or humid). If you need help quitting smoking talk to your healthcare provider.
  • 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 are 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 healthcare provider 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 healthcare provider 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 healthcare provider 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).
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. National Library of Medicine: DailyMed. Primatene Mist.

  2. Nici L, Mammen MJ, Charbek E, et al. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625ST

  3. U.S. National Library of Medicine: MedlinePlus. Epinephrine oral inhalation.

  4. Food & Drug Administration. FDA statement on approval of OTC Primatene Mist to treat mild asthma.

  5. Billington CK, Penn RB, Hall IP. β AgonistsHandb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64

  6. American Academy of Allergy, Asthma, and Immunology. Why Primatene Mist may not be the best medicine.

  7. Global Initiatve of Obstructive Lung Disease (GOLD). Pocket guide to COPD diagnosis, management, and prevention—2020 Edition.

  8. Varraso R, Camargo CA Jr. Processed meat consumption and lung health: more evidence for harmEur Respir J. 2014;43(4):943-946. doi:10.1183/09031936.00228213

By Lauren Van Scoy, MD
Lauren Van Scoy, MD, is a board-certified physician in internal medicine, pulmonary medicine, and critical care.