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The Case For and Against Nonprescription Inhaled Short-Acting Bronchodilators

Hendeles L, Hatton RC.

RDD Europe 2015. Volume 1, 2015: 203-212.

Abstract:

For more than 30 years, there has been an ongoing debate about whether short-acting inhaled beta-agonists such as albuterol should be available without a prescription. Proponents argue that nonprescription availability would increase access and convenience for patients with mild intermittent asthma or those who find themselves without their quick-relief inhaler. Also, they propose that it would likely decrease costs as has happened with other prescription-only (Rx) to nonprescription switches such as loratadine (Claritin®). Some proponents propose that nonprescription availability of asthma medications, including inhaled corticosteroids (ICS), would enable physicians to take care of more complex cases. In contrast, those opposed are concerned about the risk of overuse of beta agonists and underuse of ICS for patients with chronic asthma. They worry that nonprescription bronchodilators will delay patients from seeking medical care, and hence starting systemic corticosteroids during an acute exacerbation. They point to epidemics of asthma deaths decades earlier in Australia, New Zealand, and the United Kingdom (UK) that were associated with overuse of very potent non-selective agonists such as isoproterenol forte and fenoterol. Since there is merit to both arguments, the question is how the benefits can be achieved with minimal risk? It is our opinion that supervised availability (“behind the counter”), by a pharmacist certified to assess asthma severity and to refer patients for medical care, when appropriate, would provide the condition of safe use sought by the United States (US) Food and Drug Administration (FDA), while also offering the benefits of nonprescription availability.