Asthma sufferers could breathe easier

Despite shortage of over-the-counter epinephrine inhalers, Portlanders may find more relief elsewhere

An over-the-counter medication popular with low-income asthma patients has disappeared from pharmacy shelves in Portland area stores.

The vanishing act, though, could be a blessing: Most asthma specialists believe that Primatene Mist and its generic versions, inhaled medications that temporarily clear bronchial passages, cause users more harm than good.

The specialists believe that the medications' users could seek better care, including prescription inhalers and preventive respiratory treatment programs.

Such efforts could help Portland reduce its high volume of asthma-related hospitalizations, as well as reduce the prevalence of the disease in lower-income neighborhoods.

Primatene Mist and its generic equivalents, called epinephrine mists, which were marketed as providing temporary relief from 'physician-diagnosed mild bronchial asthma,' haven't appeared in pharmacies and stores since late spring. As nonprescription drugs, the products cost far less than prescription alternatives.

'If there's a situation where local stores don't have the medication, it puts people in a vulnerable situation because, over time, not treating the asthma will increase the severity of their condition,' said Bruce Podobnik, an assistant professor of sociology and anthropology at Lewis & Clark College who studies asthma rates in Portland neighborhoods. 'Getting access to medication is crucial.'

'Even though prescription medications are relatively inexpensive, we do recognize that people may not have the primary care physician to prescribe them,' said Don West, owner of Lloyd Center Pharmacy in the Lloyd Center. 'But prescription medications do a far more effective job.'

And, say health care pros, they do the job without several dangers posed by epinephrine.

Scary side effects

Wyeth Consumer Healthcare, the Madison, N.J., maker of Primatene Mist, temporarily stopped producing the inhaled medicine in late spring when it could no longer secure a sprayer component that delivers the medicine.

Alpharma, of Fort Lee, N.J., which makes the generic version of the inhaler, recalled 4.3 million units in April because it improperly tested a water purifying ingredient in its formula.

Wyeth spokesman Fran Sullivan said his company will be able to fill incoming Primatene Mist orders by the end of the year.

Primatene Mist contains bronchodilators, a group of drugs that widen constricted airways in the lungs.

The bronchodilators in Primatene, though, contain epinephrine, which relaxes the airways but can cause multiple side effects.

Dr. Allen Barker, professor of medicine in pulmonary and critical care at Oregon Health & Science University, said while epinephrine effectively opens breathing passages, it can cause racing of the heart and through-the-roof blood pressure.

As a result, even Sullivan admitted that Primatene might not provide the best long-term solution for asthma sufferers.

'If a consumer panics because there's no Primatene, they probably shouldn't be using Primatene,' he said. 'They should get their asthma treated by a doctor.'

Ways around 'temporary fix'

Asthma professionals couldn't agree more.

'When someone depends on drugs such as Primatene Mist, they are only getting a temporary fix,' argued Kirsten Jensen, asthma policy and programs coordinator for the American Lung Association of Oregon. 'Asthma is a chronic inflammatory disease of the airways. É The only way it becomes controlled is with the use of a corticosteroid,' a prescription-only preventive drug.

Jensen said lower-income asthma sufferers might have several avenues from which they can obtain treatments. For instance, Multnomah County offers several health care clinics for the indigent.

'It's easier than they might think,' she said. 'And children should have no problem (receiving care) because most should be covered on the Oregon Health Plan.'

Such facilities offer asthma care programs that combine prescription medications Ñ corticosteroids have become favored over albuterol, which users typically deploy to combat an attack Ñ with advice on managing triggers, or the causes, of asthma attacks.

Many times, the solutions aren't that simple. A recent Podobnik report suggests that 14 percent of North and Northeast Portland residents have asthma because they live close to Portland's freeways. In contrast, just 5 percent of those living in Southwest Portland suffer from the condition. Podobnik based his results on self-reported data from more than 800 patients.

Podobnik also found that the Southwest Portland asthma patients reported no difficulty affording their medication, while 41 percent in North and Northeast Portland reported difficulties in paying for treatment.

In all, 8 percent of Multnomah County residents suffer from asthma, compared with an 8.5 percent statewide average, said Stacey Schubert, asthma epidemiologist for the Oregon Asthma Division of the state's health department.

The numbers help explain why pharmacists such as Diana Courtney, pharmacy manager for ProCare, at 1644 E. Burnside St., offer programs that monitor how patients use asthma medications whether they're prescribed or not.

'If we notice someone buying the over-the-counter medication, we ask if they've used it before and answer questions about using the inhaler properly,' Courtney said.

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