A shot of adrenaline, for asthma?

February 3, 2009

Cheap, generic albuterol inhalers for asthma are being phased out in favor of more expensive, more environmentally friendly, inhalers.

Patients, however, are bearing the brunt of the cost, with what used to cost less than $10 now costing several times more.

This country doctor relates a story of one his patients who injected himself with epinephrine for his asthma attacks. “When his asthma kicked in,” the brave doctor who refilled the prescription writes, “he would roll up his sleeve and give himself a shot in the arm with adrenaline.”

That, my friends, takes serious balls, and I doubt we’ll be seeing doctors prescribe IM epinephrine for asthma anytime soon.

But with the recession being what it is, never say never.

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{ 8 comments }

1 JorgeRB February 3, 2009 at 3:04 pm: Wow! I wasn’t aware of this transition in inhalers used. Could you please provide a link with more information? This makes me want to explore the confrontation between environmental awareness and medicine.
2 Anonymous February 3, 2009 at 4:02 pm: Jorge – the old environmentally unfriendly albuterol inhalers were available generic, and were relatively cheap. The HFA environmentally friendly inhalers are considered “brand” drugs – like Proventil HFA. AFAIK, nobody has come out with generic albuterol HFA inhalers. Personally, I’m eagerly awaiting US availability of generic fluticasone/salmeterol inhalers(probably HFA aerosol rather than powder like Advair Diskus) – apparently the separate inhaled products are/will soon be off patent.

Kevin – is th possible that Epinephrine Injection Guy was using an EpiPen?
3 Anonymous February 3, 2009 at 4:26 pm: In case you’re interested basically they switched us from plain albuterol to albuterol HFA and that’s the one that is environmentally friendly but substantially more expensive.

I was able to buy albuterol previously for four dollars whenever I needed a bottle and now it’s something like $30
4 SarahW February 3, 2009 at 5:25 pm: I’m told the new inhalers not only cost several times more than the old, but don’t work as well.

I can’t think of a stupider thing to insist on making ozone- friendly. There are far larger contributors to ozone depletion than asthma inhalers, which ought to be an option for patients who are fool enough to think their contribution to ozone depletion has some significance, but not foisted by mandate on people who need to stay alive with this medicine.

This isn’t fricking deodorant or hairspray. This is one brilliant scheme for saving the planet that ought to be abandoned.
5 Anonymous February 3, 2009 at 6:34 pm: I am old enough to remember using epi for acute asthma. Epi x 3 then susphrine. Of course, we also used theophylline then too.
6 Dr. Matthew Mintz February 3, 2009 at 9:25 pm: JorgeRB (and others),
The conversion of asthma inhalers from CFC to HFA is not new, but many are finding out about it now because as of January, they are no longer available. Many people have found my blog post on this back in May helpful. Most insurance companies have picked one of 4 agents to be a tier 1 (generic) or tier 2 (preferred) co-pay. However, if you don’t have insurance that covers prescriptions, this will be a problem. I certainly do not recommend injectable epinephrine.
7 Anonymous February 4, 2009 at 2:17 pm: @SarahW – HFA inhalers don’t have as strong a “puff” as the old ones, which may lead to their perception as “weaker”. If you use a spacer (like an Aerochamber) you probably won’t notice it as much. YMMV.
8 Jennifer Wilcox August 6, 2009 at 8:36 pm: I was given IM epi for status athmaticus as recently as 2001. I didn’t sleep for two days after, but it was better than intubation I guess.