April 15, 2025 | Black & Kletz Allergy
There are a few over-the-counter (OTC) medications that some patients with asthma and other respiratory conditions occasionally use. One of them is an inhaler called Primatene Mist.
Primatene Mist contains epinephrine (i.e., adrenaline) in an inhalable form. Though it is the same drug that is in an EpiPen, Auvi-Q, Adrenaclick, and other self-injectable epinephrine devices as well as the nasal spray, Neffy, used to treat acute allergic emergencies such as anaphylaxis, Primatene Mist does not help in those situations and should not be used.
Although Primatene Mist became available in 1967, the FDA took it off the market in 2011, as it contained propellants called chlorofluorocarbons (CFC’s) which are harmful to the environment as they deplete ozone from the atmosphere. However, Primatene mist was recently reintroduced into the market with a newer propellant called hydrofluoroalkanes (HFA’s), which are environment friendly. Primatene Mist temporarily opens up the airways in the lungs thus offering a very short-term relief from shortness of breath and/or wheezing. It is approved only for individuals with an established prior diagnosis of asthma. It is used for the temporary relief of mild symptoms of intermittent asthma in patients aged 12 years or older and should not be used as a replacement for prescription asthma medications. Primatene Mist can do more harm than good if used for a chronic cough, for instance, without a known cause.
The risks of Primatene Mist usage include masking of the symptoms without addressing the underlying cause. The symptoms of chest tightness, wheezing, cough, and/or shortness of breath should lead to the proper evaluation in order to establish the reason behind the symptoms.
In cases of asthma, the underlying cause could be long-standing inflammation of the lungs. Proper evaluation and management should include the assessment of the lung function in addition to trying to control the causative factors. Uncontrolled inflammation can result in damage to the lung tissues and a reduction in lung capacity over time, which can be irreversible. Several deaths are reported each year in the USA due to uncontrolled asthma. Deaths also occur in cases of mild asthma with acute exacerbations.
Primatene Mist is also associated with undesirable side effects such as palpitations, increase in blood pressure, nervousness, etc. In the elderly and in individuals with certain conditions such as heart problems, Primatene Mist may be harmful as epinephrine may worsen their underlying conditions. There is also concern for misuse or abuse. Primatene Mist may make the individual feel better temporarily when in fact the underlying reason for the exacerbation of the asthma goes unchecked, leading to a worse outcome overall because the individual did not seek the proper care. Albuterol, a prescribed alternative medication, is typically used for the quick relief of asthma symptoms. It is a bronchodilator which acts by relaxing the muscles around the airways so that they can open up better making it easier to breath. Primatene Mist is less potent and has a much shorter duration of action than albuterol, and thus not preferred.
Primatene Mist is not recommended for severe asthma or as a long-term treatment. It should not be used in children under the age of 12 years old. There is a defined role for albuterol in relieving symptoms while also controls the underlying cause(s) with anti-inflammatory medications. In fact, there is an albuterol inhaler that has a corticosteroid added to it in order to give the medication an anti-inflammatory benefit when treating the symptoms of asthma. This medication is called AirSupra and it contains both albuterol and the corticosteroid called budesonide. It should also be noted that the national and international guidelines by organizations such as the National Institutes of Health (NIH) and the Global Initiative for Asthma (GINA) do not recommend using Primatene Mist.
The board certified allergists at Black & Kletz Allergy are always available for our patients to ask any questions that they may have regarding asthma or allergies. We have been treating adult and pediatric patients with asthma for more than 50 years. In addition, we diagnose and treat individuals with allergic rhinitis (i.e., hay fever), allergic skin conditions such as urticaria (i.e., hives) and atopic dermatitis (i.e., eczema), eosinophilic disorders, insect sting allergies, medication allergies, and immune disorders. We have 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you would like to be evaluated today for asthma or any other allergic or immunologic problem, please call us today. You may also click Request an Appointment instead and we will respond to your request within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy pride themselves in providing the highest quality asthma and allergy care in the Washington, DC metro area.
