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Asthma Attacks

Rescue Inhalers

  • By SimonHolzman

    I almost only get asthma when I am sick and, occasionally from exercise (and from dogs, but I can mostly avoid those). Very rarely, I get an acute attack for no apparent reason, however.

    Doctors seem to think my asthma is more serious than it really is because they tend to see me when I am sick and so my asthma is flaring. (Indeed, me being chesty is usually the first sign that I am getting sick.)

    So, they have put me on every chronic treatment from Advair to Singulair, none of which have had any impact on the frequency or severity of my acute attacks. Meanwhile, when I do get an acute attack, I have generally relied on a Rescue Inhaler to alleviate the symptoms (because “not being able to breathe” is more serious an issue than “I have asthma” – the symptom IS the problem !)

    Doctors have tried to get me to use Albuterol, but it does not seem to help me at all. On looking at the information about the drug, perhaps that is because it take “3-5 minutes” to have an effect and perhaps because the effect is relatively gentle… MAYBE my breathing is a little better 5 minutes later because of the Albuterol. Or maybe it is just because the attack has become a little less severe of its own accord – I have adapted my breathing so that I can get enough air in to survive.

    On the other hand, Primatene Mist worked GREAT for me. I can feel the difference immediately with Primatene – The first puff gets enough medicine in that I can breathe the second puff deep into my lungs where it can do the job properly. And, yes, I do still have part of my stash of 6 PM refills from before they were banned, which shows how rarely I use them. I have never needed to go to the ER due to an attack, which is a good thing since I live 30 minutes away from the nearest one.

    I’m frustrated by the ban on Primatene Mist because as far as I can tell, it is still the only real Rescue Inhaler – Albuterol is too slow acting – On the rare occasions when I have a serious attack, I need to be able to resume breathing NOW, not in five minutes.

    I also miss Primatene Mist because it was the only OTC rescue inhaler for a very long time. It wasn’t cheap, but it was cheaper than a Co-pay and a deductible and, most importantly, it was easy to get 3 or 4 of them so that I had one at home, one at work and one in my car and so did not actually need to carry it with me all the time. Or, if I was out of town, I could get another one at the nearest pharmacy without needing to arrange an RX. In theory there are other OTC Rescue Inhalers, but the only one I have seen available seems to be a Herbal Remedy – and I do not trust those due to the lack of testing that they require, some are great, but some are snake oil.

    I am aware that Primatene Mist was potentially more dangerous to the heart and, on one or two occasions, I have taken too much and had a few minutes of palpitations. But I could breathe throughout them, which is all I cared about at the time.

    Does anyone have any recommendations for other Rescue Inhaler options, or information on when an epinephrine inhaler will become available again, whether OTC or RX ?

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  • By Leon Lebowitz, RRT Moderator

    Hi SimonHolzman and thanks for sharing both your experiences and views on asthma, inhalers and medications. When it comes to Primatene Mist you are certainly not alone! I too remember having several of those inhalers stashed around for when breathing became difficult unexpectedly and very quickly. Primatene Mist to the rescue! But, as a plethora of new medications (with far fewer side affects) became available, most patients quickly acclimated to the new drugs.
    You seem to have your asthma sized up correctly for yourself and subscribe to self medication since, as you stated, this seems to be the only medication that provides you with instant relief and quells your asthma attack.
    Although I don’t (professionally) forsee any new epinephrine based inhalers coming down the pike, I’m not sure how to tell you what to look for in the future. You may want to take this up with your physicians since they will be the ones treating you when you run out of PM.
    As well, you may want to sit with a nebulizer treatment of albuterol. Sometimes sitting calmly for 5-10 minutes breathing the medicated aerosol is what does the trick You may never know if it’s the length of time OR the medication OR a combination of the two. But you do want to get past your episode of difficulty breathing attributed to your asthma condition.
    All the best,
    Leon (site moderator)

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  • By SimonHolzman

    The benefit of the Rescue Inhaler is its immediacy.

    The Albuterol based ones do not help me anything like as quickly as the Epinephrine ones do and a Nebulizer treatment takes time to set up and is not available most of the time.

    There was another epinephrine based one available a while back (asthmanefrin) but I gather there were some issues with the dispenser so it got pulled from the market and now only refills are available for use with a Nebulizer.

    Perhaps there are two types of asthma – chronic with flare-ups, which responds well to beta-antagonists, and recurrent acute asthma that does not respond to beta-antagonists but DOES respond to epinephrine. This might explain why some sufferers love PM and some hate it. Perhaps doctors think that the recurrent acute sufferers are really chronic sufferers that normally have very mild symptoms and so do not realize that they are always affected. Since the beta-antagonists work well to control the chronic disease, the doctors assume that treatment will work for everyone.

    As for a nebulizer… I have never tried one. I get almost immediate relief from PM but, when I don’t have it, trying to calm down and relax serves almost no purpose (whether or not I use the Albuterol puffer) – Getting stressed seems to make my asthma worse, but calming down does not seem to improve it !

    I cope by taking very shallow breaths that allow me to keep breathing and, usually, to fall asleep. When I wake, I am usually better. Now, maybe this IS the “calming down” for me although it feels like I am calm long before I fall asleep and I am still unable to breathe properly. My daughter has an albuterol nebulizer that seems to work for her so maybe I’ll try it sometime.

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  • By Leon Lebowitz, RRT Moderator

    Hi again Simonholzman:
    Thanks for your reply, we hear you!!

    You may be aware that YOU can calm down a bit quicker than your airways. Once you are wheezing, your airways become constricted and inflamed and even congested. It takes them longer to recover, even when using medication.

    If you haven’t as yet, you may want to check out our (free) website. You can register here: asthma.net/register.

    It sounds like you do have your asthma condition under control You know how to handle the exacerbations and what you need to do to recover. We appreciate you sharing your experiences with our online community.
    Warm regards,
    Leon (site moderator)

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