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[blog updated April 2019]
I just read in The New York Times today that after a decade the FDA approved putting the asthma inhaler Primatene Mist back on the pharmacy shelves. A new version of this once popular asthma inhaler will soon return to stores. For people 12 and older, it is used for temporary relief of mild intermittent asthma symptoms.
Why is this bad news? This is slightly complicated to explain but I hope you will read my assessment carefully below and realize the proper and safe way to control your asthma.
What is Primatene Mist?
Primatene Mist is an inhaler intended for asthmatic patients that contain epinephrine -the lay term is adrenaline. It is one of the original medications used for asthma and has been around for over 50 years. The mist or inhaler was seen as a breakthrough treatment back in its time because before it existed patients would have to go to an Emergency Room when having an asthma attack to get an injection of epinephrine to try and open the patient’s lungs. Once Primatene Mist came on the market asthma sufferers had another option besides the emergency room.
Why is Primatene Mist Bad?
The reason Primatene Mist was removed from pharmacy shelves a decade ago was that there were several deaths related to its usage. In fact, a frightening recurring image was a patient who died from an asthma attack holding a Primatene Mist inhaler clutched in their hand. It wasn’t that the Primatene Mist didn’t initially give the patient some relief but that its repeated use causes it to lose effectiveness. As a result, the side effects become more frequent.
According to Healthline.com, offices are saying the reformulated inhaler only masks the symptoms and doesn’t treat the ailment. It is also concerning because people who use Primatene Mist are also more likely to overuse the new inhaler or fail to report their symptoms to their medical providers.
The understanding of asthma has evolved tremendously over the 30 years I have been a physician. Today, it is common knowledge that the pathophysiology of the bronchioles (the tubes inside the lungs that pass oxygen) in asthma involves 2 key components: the anatomical space or diameter of the bronchiole airway and the lining of this airway.
All the new asthma medications – that are by prescription only – address these two components. These medications such as Symbicort or Advair, have a dual component, whereby they widen the lung diameter also termed bronchodilation and have inhaled cortisone which breaks up the mucus plugs that block the air from flowing through.
In contrast, Primatene Mist is only a bronchodilator and doesn’t break up mucus. Think of this analogy: A big truck trying to go through a narrow street that’s blocked by double-parked cars. The Primatene Mist tries to plow through the street gunning the engine to try and barely slide through. In contrast, the Symbicort or Advair with their dual action is actually removing the double-parked cars and so the passageway is cleared.
Final Verdict: Primatene Mist is a Bad Choice
If you or someone you love suffers from asthma please urge them to see a physician who can properly guide them to control their symptoms. In my book, Dr. Dean Mitchell’s Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time, I devote a whole chapter to working with your doctor on an Asthma Action Plan. I find that when a patient understands the different steps to control their asthma they rarely get too severe – I haven’t had a patient go to the Emergency room with asthma in a decade.
My last key point is to see your doctor to be evaluated for allergies if you have asthma. The medical research strongly shows that 80% of asthmatics have underlying allergies.
– Dr. Dean Mitchell, M.D.
Mitchell Medical Group, NYC
About the Author – Dr. Dean Mitchell, M.D.
Dr. Dean Mitchell, M.D. is a Board Certified Allergist and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Clinical Assistant Professor of Clinical Immunology at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma and Immunology, and the author of Dr. Dean Mitchell’s Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.
Puglia, Michelle. “Allergy Groups Urge People with Asthma Not to Use New Primatene Mist Inhaler.” Healthline, November 13, 2018.