Can I Use an Over-the-Counter Inhaler for COPD?

Over-the-counter (OTC) inhalers are not approved for treating chronic obstructive pulmonary disease (COPD). Aside from the fact that they are ineffective for COPD, these inhalers can pose risks including masking symptoms and increasing treatment side effects.

There are only a few OTC inhalers available. These products are either approved for treating mild asthma symptoms or cold and flu symptoms, but not COPD. People with COPD should not use these products in place of the short-acting bronchodilator prescribed by a healthcare provider.

This article discusses OTC inhalers and why they are not recommended for people with COPD.

OTC vs. Prescription Inhalers

There are no OTC medications approved for the treatment of COPD. The condition is managed with a combination of short-acting bronchodilators like albuterol for acute symptoms and long-acting maintenance medications to prevent exacerbations.

Short-acting bronchodilators are used as a rescue inhaler to treat acute COPD symptoms of dyspnea (shortness of breath), chest tightness, wheezing, and coughing spells.

Prescription rescue inhalers deliver a class of drugs known as short-acting beta 2-agonists (SABAs). The OTC inhaler Primatene Mist (epinephrine inhalation aerosol) is also a short-acting bronchodilator. It contains epinephrine, the drug form of the hormone adrenaline that is commonly used to treat allergic reactions.

Epinephrine is not recommended as a substitute for prescription SABAs, which are the gold standard for treating acute COPD exacerbations. These include:

• Proventil HFA, Ventolin HFA, ProAir HFA (albuterol)
• Xopenex HFA (levalbuterol)
• Alupent (metaproterenol)
• Maxair (pirbuterol)

Risks and Concerns

Over-the-counter inhalers are approved by the Food & Drug Administration to treat mild, acute asthma. These products temporarily relieve asthma symptoms and should not be used as a replacement for prescription inhalers. They are not approved for COPD.

Using an over-the-counter breathing treatment for COPD raises the following concerns. You should not use one without first consulting with your healthcare provider.

Ineffective For COPD

While SABAs and Primatene Mist are short-acting bronchodilators, they are not equal.

SABAs bind to the beta 2-adrenergic receptor, signaling the smooth muscle tissue of the lungs to relax and dilate the bronchi and bronchioles, relieving bronchospasms that cause chest tightness and coughing.

Epinephrine, an alpha- and beta-adrenergic agonist, works similarly to SABAs to make breathing easier, but not as well. Epinephrine may be helpful for treating an asthma attack, but it does not appear to be effective during a COPD flareup.

Masks Worsening COPD

A progressive lung illness, COPD should be managed by a medical professional. If you are reaching for an OTC inhaler, that may be a sign your COPD is not well controlled on your current medication regimen.

Short-acting bronchodilators are the first-line inhalers for COPD, but may not be enough to control symptoms long-term as the disease progresses. Most people with COPD also need to use long-acting controller medications to prevent symptoms and dangerous flare-ups.

Using an OTC inhaler may mask a worsening of your condition and delay you in getting appropriate medical care.

Prevent Better COPD Control

COPD exacerbations are serious and often require hospitalization. Instead of adding an OTC medication on your own, which is unlikely to be effective and may be dangerous, ask your healthcare provider for an action plan for managing flare-ups. Tell your healthcare provider anytime you experience an exacerbation.

If you are unable to manage your COPD on prescription rescue inhalers alone, your healthcare provider will likely prescribe one of the following for long-term symptom management and prevention of exacerbations:

• A long-acting beta-agonist (LABA) such as Serevent (salmeterol)
• A long-acting anticholinergic/antimuscarinic antagonist (LAMA) such as Spiriva (tiotropium bromide) or Yupelri (revefenacin)
• A combination inhaler such as Stiolto Respimat (tiotropium/olodaterol)

Increased Side Effects

Taking OTC epinephrine alongside other short-acting bronchodilators may cause unpleasant side effects. Though not contraindicated for combined use, both epinephrine and albuterol-type medications can increase your heart rate and cause nervousness and tremors. Combining medications can increase this effect.

If you continue to have difficulty breathing or experience chest pain, seek immediate medical help.

Non-Drug Ways to Improve COPD Management

If you have COPD and are reaching for an OTC inhaler because you are struggling to manage symptoms there are a few non-drug ways to improve your condition in addition to using your medications as prescribed.

• Lose Weight: Carrying excess pounds can make breathing more difficult, so losing weight if you are overweight can help improve your symptoms.
• Exercise: Even if you don't need to lose weight, getting regular exercise—even something as simple as walking around the block—can help to improve lung function.
• Eat Right: Avoid processed foods, junk food, and meats cured with nitrates, which are shown to exacerbate COPD symptoms. Instead, aim for healthy whole foods with lots of fruits and vegetables.
• Avoid Triggers: Identifying and avoiding things that aggravate your lungs can help to prevent a COPD flare-up. While COPD triggers are different for everyone, common triggers include cigarette smoke, dust, air pollution, and extreme weather (hot, cold, or humid). If you need help quitting smoking talk to your healthcare provider.
• Stay Healthy: People with COPD are more prone to severe upper respiratory infections that lead to exacerbations of breathing problems. Prevent catching contagious illnesses by staying up to date on your vaccinations, washing your hands frequently, avoiding people who are sick, and wearing a mask in indoor public places during periods of influenza or COVID-19 outbreaks in your area.

If You Can’t Afford Your Prescriptions

The high cost of prescription medications can lead some people with COPD to substitute with OTC inhalers. If you are struggling to pay for the medications your healthcare provider prescribed, there are a few things you can do.

If you have prescription drug insurance, call to find out the preferred medications for treating COPD. These will typically have a reduced copay compared to medications in a higher tier on the prescription drug formulary.

Your healthcare provider may be able to switch you to a similar medication with a lower out-of-pocket cost to you.

In addition, the patents on several COPD medications have expired in recent years, opening the market to lower-priced generic drugs that your healthcare provider can prescribe instead. These include:

• Short-acting bronchodilators: Ventolin, Xopenex, and Proair
• Combination LABA and corticosteroids: AirDuo (fluticasone/salmeterol), which is comparable to Advair Diskus
• Inhaled corticosteroids: Pulmicort (budesonide)

Many pharmacies and drug companies also offer coupons that can save you money on your medications with prescription discount cards. The following COPD drug manufactures offer programs that can help offset the cost of treatment:

• AstraZeneca has prescription discount programs for eligible patients for the drugs Pulmicort and Symbicort (budesonide/formoterol).
• GlaxoSmithKline offers assistance to patients without insurance or with Medicare Part D for Advair (fluticasone propionate), Breo Elipta (fluticasone/vilanterol), Flovent (fluticasone propionate), and Serevent (salmeterol).
• Merck has a program that provides medications free of charge to eligible patients including Asmanex (mometasone), Dulera (mometasone/formoterol), and Proventil.
• TEVA Pharmaceuticals provides discounts for eligible patients through the TEVA Cares Foundation for both ProAir and QVAR (beclomethasone dipropionate).

Summary

OTC inhalers can help treat mild asthma symptoms, but they do not treat COPD. These inhalers contain different ingredients and have not been shown to help relieve COPD symptoms. They may also prevent some people from seeking the advice of a healthcare provider for managing COPD.

You can help reduce your COPD symptoms in other ways, such as changing your diet, losing weight, and avoiding triggers. If you can't afford your medication, talk to your health insurance company or pharmacist to see if discounts or generic drugs are available.