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Fact Checked

What Is Albuterol?

The leading chronic disease for children has been on the rise since the 1980s across all genders, races, and age groups. Can you guess what it is? If you guessed asthma, you’d be correct. An estimated 25 million Americans suffer from asthma or approximately one in every 13 people. The Centers for Disease Control and Prevention (CDC) estimates that approximately 7.7 percent of adults and 8.4 percent of children in the United States have asthma, and people with the condition are no stranger to how serious and scary the condition can be, especially when it is severe. More than 11.4 million people had one or more asthma episodes or attacks in 2017, and while some people may be able to control their symptoms with over the counter medications, many others rely on inhalers to help them breathe more easily. People with serious or life-threatening asthma may rely on emergency or rescue inhalers for help during an attack, but inhalers can also be used preventatively to keep the airways open and avoid an attack. Albuterol is one of several different medications that can help asthma sufferers, but what is albuterol and how does it work?

What Is Albuterol?

Albuterol is a short-acting bronchodilator nebulizer that quickly helps people suffering from wheezing or shortness of breath associated with several medical conditions. Albuterol is dispensed in an HFA (hydrofluoroalkane) inhaler canister, which is a relatively new type of inhaler that was designed to improve upon chlorofluorocarbon (CFC) inhalers, which were in use for many years before being banned by the federal government in 2008.  HFA inhalers like albuterol deliver asthma medication in a more gentle manner than CFC inhalers,  and they are also considered to be better for the environment. Albuterol is an active ingredient in short-acting HFA inhalers like Proventil HFA, ProAir HFA, and Ventolin HFA, and it was previously used as the active ingredient in several CFC inhalers prior to the 2008 ban. Although most of the brand name HFA inhalers remain under patent and are sold exclusively by their manufacturers, the manufacturer of Ventolin, GlaxoSmithKline, recently released a generic form of the medication, which is sold as albuterol sulfate. The release of generic albuterol in an HFA inhaler has had a major impact on patients because HFA inhalers have been sold at high prices since they were released due to active patents and the ban on CFC inhalers. The average amount spent on prescription medications for asthma was $1,830 as recently as 2013, making affording their medications a major hardship for many patients. 

What Conditions Is Albuterol Used to Treat?

Albuterol helps improve breathing for people with medical conditions that cause the bronchial muscles to tighten, such as asthma.  Albuterol is primarily used to treat two conditions: asthma and chronic obstructive pulmonary disease (COPD). Albuterol inhalers are most frequently used as “rescue” or emergency inhalers, but they can also be used for preventative maintenance treatment of asthma and COPD.

Asthma

Asthma is a chronic disease in which the air passageways narrow and become inflamed and excess mucus production occurs, making it difficult to breathe. Asthma can range in severity from relatively minor to a serious, life-threatening condition, and the severity can change over time. Doctors most frequently diagnose asthma by completing a physical exam, lung function tests, and a chest or sinus x-ray on a patient suspected of having the condition. Asthma is triggered by things like dust mites, exercise, pollen, extreme weather changes, chemicals, smoke, and stress, and each person’s triggers are different. People with asthma must learn to identify their triggers and avoid them where possible. Symptoms of asthma include coughing, shortness of breath, wheezing, and chest tightness, and it can cause a medical emergency. 

Chronic Obstructive Pulmonary Disease 

Chronic obstructive pulmonary disease, or COPD, is a chronic lung disease that is characterized by the presence of one or more of the following conditions: refractory asthma, chronic bronchitis, and emphysema. Refractory asthma is irreversible asthma that doesn’t respond to normal asthma medications. People with chronic bronchitis experience a lingering cough, shortness of breath, and excess mucus production that lasts at least three months per year for two years in a row. Emphysema is characterized by damage to the air sacs in the lungs, called alveoli. When the alveoli are damaged, they are unable to absorb as much oxygen, resulting in shortness of breath. There are four different stages of COPD depending on the severity of the symptoms, but many people do not experience noticeable symptoms until their COPD is advanced. Symptoms of COPD include a lingering cough, a productive cough, wheezing, fatigue, shortness of breath, chest tightness, blue lips or fingernails, frequent colds, and more. 

How Does Albuterol Work?

Albuterol belongs to a class of drugs called adrenergic bronchodilators. In general, adrenergic drugs work by stimulating the response and actions in the sympathetic nervous system, which controls our physical response to stress or an emergency. The sympathetic nervous system is what is responsible for what is known as the “fight or flight” response, where the body releases chemicals like epinephrine and norepinephrine to provoke specific responses in the body. These responses, including increased blood pressure, the opening of the airways, and increased heart rate, prepare the body to either fight for survival or escape from a dangerous situation. Adrenergic medications provoke the fight or flight response therapeutically, meaning that they use the sympathetic nervous system to help fight an internal emergency, like asthma.  During an asthma attack, the airways close and the patient can’t breathe. When used in an inhaler, adrenergic medications like albuterol can provoke the fight or flight response more quickly to reopen the airways. Specifically, adrenergic bronchodilators are beta2-adrenoreceptor agonists, meaning they bind directly to beta2 receptors in the bronchial smooth muscle. When beta2-adrenoceptor agonists bind to the bronchial smooth muscle, the muscle relaxes, which helps to open the bronchial airways, allowing air to enter the lungs. Patients with respiratory diseases such as asthma, COPD, emphysema, and bronchitis use adrenergic bronchodilators to help improve their breathing in emergency situations.

What Dose of Albuterol Should I Use?

Albuterol inhalers are designed to treat or prevent the symptoms of asthma and bronchospasm and should only be used as directed based on the drug information provided. Patients ages four and older should use two sprays taken every four to six hours to treat the symptoms of an asthma attack or prevent an attack. The medications begin working within minutes and provide relief of symptoms for four to six hours. However, it is very important that patients do not take additional doses of the medication, as inhaling too much albuterol has been associated with an increased risk of overdose and death. The inhalers feature a built-in dosage counter that shows the number of sprays remaining in the inhaler and should be stored at room temperature. Patients can purchase a metered-dose inhaler with either 204 or 64 sprays, and the counter cannot be reset without getting a refill from a healthcare professional. 

How Much Does Albuterol Cost?

Albuterol offers a welcome alternative to the high prices of brand name HFA inhalers. When CFA inhalers were banned in 2008, HFA inhalers had a monopoly on the market and their patents meant that they had a monopoly on the market. This kept costs high for over a decade until GlaxoSmithKline, the manufacturer of Ventolin, released a generic albuterol HFA inhaler. Today, prices are substantially lower for both Ventolin and albuterol, with albuterol offering the most economical option; the average price for generic albuterol inhalers is approximately 30 dollars. Albuterol is covered by most insurance plans, including Medicare and Medicaid, as well as most commercial insurance programs, as it is the only generic fast-acting inhaler on the market. However, insurance may not always offer the best prices on prescription drugs. Pharmacy discount card programs like USA Rx also offer savings on all FDA-approved brand name and generic medications, including albuterol, and patients can sign up for free. 

What Are the Benefits Associated With Albuterol?

Albuterol’s major benefits include the effective treatment of asthma in case of an emergency in addition to its ability to prevent asthma attacks when used preventatively. Albuterol is less expensive and more likely to be covered by insurance companies than other brand name medications in its class, which makes it more accessible and affordable for patients, no matter what their socioeconomic status. Albuterol helps to reopen the airways during an asthma attack by relaxing the bronchial smooth muscles. Albuterol is considered safe for women who are pregnant or breastfeeding, and they can be used by children as young as four. Patients with exercise-induced asthma can effectively use albuterol to prevent asthma attacks when taken prior to exercise. In general, HFA inhalers like albuterol are considered safer to use and better for the environment than the CFA inhalers that were banned in 2008.

Are There Any Risks or Warnings Associated With Albuterol?

For patients with severe asthma, albuterol can be a life-saving medication when used properly.  However, there are also risks associated with the use of albuterol, some of which can be life-threatening. Risks and warnings associated with albuterol include:

  • Albuterol should not be used in patients under four years of age.
  • Patients should be shown how to use an albuterol inhaler properly prior to use. 
  • Patients should not increase their dose of albuterol without their doctor’s approval, as people who use too much albuterol can die from abusing the medication. It is possible to overdose on albuterol. 
  • People who are allergic to albuterol sulfate should not use albuterol.

What Possible Side Effects Are Associated With Albuterol?

Common side effects associated with albuterol include:

  • Nervousness
  • Upper respiratory tract infection, including viral infection
  • Muscle pain and back pain
  • Chest pain
  • Shakiness
  • Dizziness
  • Sore throat and dry mouth
  • Cough
  • Pounding or racing heartbeat or irregular heart rhythms
  • Fast heart rate

Patients experiencing any of the common side effects listed above generally do not need to seek medical attention. However, if the side effects are persistent or begin to worsen, get immediate medical advice from your healthcare provider. There are some serious side effects associated with albuterol that require medical attention. Serious side effects associated with albuterol include:

  • Possible death in people who use too much albuterol
  • Changes in laboratory blood values, including blood sugar and potassium
  • Heart problems, including faster heart rate, irregular heartbeat, and hyperthyroidism
  • Worsening trouble breathing, coughing, and wheezing (paradoxical bronchospasm), which most commonly occurs with the first use of a new inhaler
  • Serious allergic reactions. Signs of an allergic reaction include:
    • Rash
    • Swelling of the face, mouth, or tongue
    • Hives
    • Breathing problems

What Drugs Interact With Albuterol?

Albuterol has been known to experience drug interactions with other prescription drugs, over the counter drugs, vitamins, supplements, and herbs. Therefore, patients should give their doctor a complete medication list before taking albuterol. Albuterol may interact with the following types of medications:

  • Digoxin
  • Monoamine oxidase inhibitors (MAOIs)
  • Tricyclic antidepressants
  • Other inhaled medications or asthma medicines
  • Beta-blockers
  • Diuretics

Is Albuterol Safe for Use in Pregnant and Breastfeeding Women?

It is impossible to determine what effect pregnancy will have on a woman’s asthma, as research shows that pregnancy improves asthma symptoms in approximately one-third of women, worsens asthma symptoms in approximately one-third of women, and has no effect on the asthma symptoms of the final third. However, in general, an asthma diagnosis is not a reason to avoid pregnancy. Albuterol is categorized as a Category C medication for pregnant women by the FDA, which means that there has not been enough research done on either medication to determine if there is a risk to pregnant women. Because rescue inhalers like albuterol are life-saving medications, the benefits of using the inhalers outweigh the risks, so doctors generally recommend that women continue to use their inhalers during pregnancy. Uncontrolled asthma can cause blood oxygen levels to fall in pregnant women, which reduces the amount of oxygen the fetus receives. Doctors have also found that controlling your asthma lowers the risk of pregnancy complications like low birth weight, premature birth, and preeclampsia, or high blood pressure during pregnancy. Albuterol is also considered safe to use while breastfeeding, but patients should always check with their doctors regarding the safety of any medications they are taking.

Published July 14th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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