An asthma attack feels a lot like you’re trying to suck your air into your lungs through one of those tiny little straws they give you to stir coffee with. You feel like you’re suffocating, and you can’t stop coughing. It’s unpleasant, scary, and even occasionally fatal. Asthma is a particularly troublesome condition for preppers because the best treatments for it are by prescription only. That makes it very difficult to stock in depth. There is one over-the-counter (OTC) inhaler meant for treating asthma attacks that is once again available, however: epinephrine.
Please note, folks: I am not a physician and I don’t give medical advice. I relate here some information; you make your own decisions.
Asthma rescue inhalers, old-school: Epineprhine
Inhalable epinephrine, sold under the brand name Primatene Mist, was the original rescue inhaler for people having asthma attacks. You could buy it over the counter up until 2011. Then it was pulled from the market. All the remaining asthma medications were by prescription only.
Epinephrine, also known as adrenaline, is the main hormone we release as part of our short-term stress response. It has a lot of actions. Some of them are raising heart rate, making your heart beat harder, constricting blood vessels to raise blood pressure, increasing alertness and anxiety … and relaxing the smooth muscle around your small airways and decreasing the mucus release in those airways.
Those last two actions, relaxing airway smooth muscles and decreasing mucus release, reverse two of the most significant things that happen in an asthma attack. So, epinephrine can relieve some of the worst symptoms of an asthma attack.
Why did epinephrine inhalers go away, then come back?
It’s not because epineprhine inhalers don’t help against asthma symptoms. They do help. It’s not because there are better medications. There are better medications, but that by itself doesn’t get an effective drug pulled. It’s not because of nasty side effects. There are some troublesome side effects, but breathing is kinda important so the cost/benefit analysis still could work in epinephrine’s favor.
The re-issued epinephrine inhalers no longer use the banned CFCs.
Epinephrine inhalers got pulled when chlorofluorocarbons (CFCs) got banned because of their ozone-damaging qualities. CFCs were the propellant in those inhalers. Since the epinephrine inhalers were no longer medically necessary (other options were available by then), they didn’t get an exemption from the CFC ban and their sale was stopped.
So why are they back? Because their producer reformulated the inhalers to no longer use CFCs. Since it wasn’t a medically-motivated ban, all they had to do was show the FDA the inhalers still worked in the way originally approved.
Why a prepper might consider epinephrine inhalers
Of all the drugs approved for asthma symptoms, the epinephrine inhalers are the only really effective ones that can be purchased without a prescription. Being unregulated, there’s nothing to stop a prepper from having a supply on hand. If there was anyone in my group with asthma, that would be a big, hairy deal to me.
There’s also the fact that Epi-Pens, use to treat the life-threatening allergic reaction called anaphylaxis, is also an epinephrine product. Epi-Pens are also by prescription only and very expensive. Would an epinephrine inhaler do enough if a person was having an anaphylactic reaction and didn’t have an Epi-Pen? I don’t know. If it were me in that situation, I’d try it. An asthma attack with no remedy to hand is pretty awful.
Some downsides of epinephrine inhalers
A lot of physicians are apparently not happy that epinephrine inhalers are back. Why? Leaving potential financial reasons aside, here are some that preppers should be considering.
First, there are better asthma medications out there. When you inhale epinephrine, you are likely to get at least some response from all the systems that respond to epinephrine. That means blood pressure is likely to go up, and heart rate too. Anxiety can get worse, and forget getting to sleep anytime soon. Too much of these effects can certainly pose a real danger. More modern prescription meds have fewer of these effects. The modern versions also tend to last longer, which reduces how many doses are taken.
Second, epinephrine does help relieve some troublesome symptoms. It doesn’t do spit to actually treat the underlying problem of airway inflammation that is the heart of asthma. If a person self-medicates with epinephrine and doesn’t get professional care, they miss getting the treatments that actually do reduce the core problem.
And a question mark
I haven’t been able to find how long the new version of the epinephrine inhalers last; their shelf life. That’s another potential problem. I’ve used epinephrine in lab work, and in that setting its shelf life in solution stinks. It doesn’t get more toxic or anything, but it gets useless. Does the inhaler formulation get around that problem? I don’t know. I’d ask the pharmacists if I were tempted to buy this product.
I’m not going to buy it. No one I’m prepping for needs either asthma medication or Epi-Pens. Those are the only two conditions that would make me think carefully about the cost/benefit balance of this product. Still, I’ll admit I’m glad to hear it’s back. Options for people with asthma are better than no options.
