Ventolin vs. Albuterol: What’s the Difference?
Dr. Angel Rivera
If you’re one of the estimated 25 million Americans who suffer from asthma, you know exactly how scary asthma can be. The Centers for Disease Control and Prevention (CDC) estimates that one in every thirteen people with approximately 7.7 percent of adults and 8.4 percent of children in the United States affected. Rates of asthma in the general population have been on the rise since the 1980s for all races, age groups, and genders, and the disease is the leading chronic disease in children. More than 11.4 million people had one or more asthma episodes or attacks in 2017, and many of them rely on inhalers to control their symptoms. Rescue inhalers are a lifeline for people with serious or life-threatening asthma, and while they are often used in an emergency, they can also be used preventatively prior to the onset of asthma. Ventolin and albuterol are two popular inhalers that are used to treat asthma in children as young as four. When it comes to Ventolin vs albuterol, what is the difference? For the most part, the two medications are very similar and are used in the same way, but they do have one major difference: cost.
Ventolin, also known as Ventolin HFA, is a short-acting bronchodilator nebulizer that quickly helps people suffering from wheezing or shortness of breath associated with several medical conditions. Ventolin is dispensed in an HFA (hydrofluoroalkane) inhaler, which is a new type of inhaler that was designed to improve upon chlorofluorocarbon (CFC) inhalers that were popular for many years before being banned in 2008. HFA inhalers like Ventolin deliver the “blast” of medication associated with inhalers more gently than CFC inhalers, so patients making the switch initially were concerned that they were not receiving as much medication. Albuterol is the generic version of Ventolin HFA and was released in 2019 by the manufacturer of Ventolin HFA, GlaxoSmithKline. Albuterol is a common active ingredient in many inhalers, including Proventil HFA, ProAir HFA, and Ventolin HFA, and it was previously included in CFC inhalers prior to the 2008 ban. The release of albuterol in an HFA inhaler was significant because HFA inhalers had been extremely expensive due to their active patents and the ban on CFC inhalers. Many patients struggled to afford their medications, as the average amount spent on prescription medications for asthma was $1,830 as recently as 2013.
Ventolin and albuterol both belong to a class of drugs called adrenergic bronchodilators. In general, adrenergic drugs work by stimulating the nerves in the sympathetic nervous system, which controls our physical response to stress or an emergency, also known as the “fight or flight” response. During stressful situations, the body releases chemicals like epinephrine and norepinephrine to provoke specific responses in the body, such as increased blood pressure, opening of the airways, and increased heart rate. Adrenergic medications provoke the fight or flight response therapeutically; for example, during an asthma attack, the airways close and the patient can’t breathe. An adrenergic medication helps 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, such as during an asthma attack.
Ventolin and albuterol are both used to open the airways and improve breathing for people with medical conditions that cause the bronchial muscles to tighten. The two main conditions treated by both Ventolin and albuterol are asthma and chronic obstructive pulmonary disease (COPD). While Ventolin and albuterol can both be used for either maintenance treatment of asthma and COPD or as rescue treatment for an acute attack, they are most frequently used as emergency “rescue” inhalers.
Asthma is a chronic disease that causes narrowing inflammation of air passageways and the production of excess mucus, making it difficult to breathe. The severity of a person’s asthma can range from a minor inconvenience or nuisance to a serious, life-threatening condition. Asthma is generally diagnosed by a physical exam, lung function tests, and a chest or sinus x-ray. Symptoms of asthma include coughing, shortness of breath, wheezing, and chest tightness, and it can cause a medical emergency. Asthma is triggered by things like pollen, extreme weather changes, dust mites, exercise, 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.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease, or COPD, is a chronic lung disease that is characterized by the presence of chronic bronchitis, emphysema, and/or refractory asthma. Chronic bronchitis is characterized by lingering cough, shortness of breath, and excess mucus production that lasts at least three months per year for two years in a row. Emphysema occurs when the air sacs in your lungs, called alveoli, are damaged and cannot absorb as much oxygen, resulting in shortness of breath. Refractory asthma is irreversible asthma that doesn’t respond to normal asthma medications. 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.
Use and Dosage
Ventolin and albuterol inhalers are designed to treat or prevent the symptoms of asthma and bronchospasm. The recommended dose for patients ages four and older both inhalers is two sprays taken every four to six hours to treat the symptoms of an asthma attack. The medications begin working within minutes and provide relief of symptoms for four to six hours. Patients should not increase their dose or take extra doses of albuterol or Ventolin because taking too much of the medications has been associated with an increased risk of death. The inhalers feature a built-in dosage counter that shows the number of sprays remaining in the inhaler. Patients can purchase an inhaler with either 204 or 64 sprays, and the counter cannot be reset.
By far the biggest difference between Ventolin and albuterol is the cost of the two medications. With the ban on CFA inhalers in 2008, HFA inhalers had a monopoly on the market and were brand name medications that were under patent and therefore could not be produced in a generic form. This kept costs high for over a decade until GlaxoSmithKline, the manufacturer of Ventolin, released a generic albuterol HFA inhaler. The average cash price for a brand name Ventolin HFA inhaler is approximately 74 dollars, while the average price for generic albuterol inhalers is approximately 30 dollars. Ventolin was previously covered by the majority of insurance programs, but with the release of the generic version of the medication, many insurance companies list albuterol as the preferred drug. The manufacturer offers a savings program on their website for patients with commercial insurance who do not receive coverage for the medication and patients without insurance. Because there is a generic version of Ventolin available, Ventolin and albuterol are available at a lower cost compared to other drugs in the same class. Pharmacy discount card programs like USA Rx also offer savings on all FDA-approved brand name and generic medications, including Ventolin and albuterol, and patients can sign up for free.
Ventolin and albuterol both offer similar benefits - namely, the effective treatment of asthma in case of an emergency, as well as the ability to prevent asthma attacks. Compared to Ventolin, albuterol is less expensive and more likely to be covered by insurance companies than the brand name medication. However, both medications are less expensive than other medications in their class due to the availability of the generic albuterol. Ventolin and albuterol help to relax the bronchial smooth muscles, allowing the airways to reopen during an asthma attack. Both medications are considered safe for women who are pregnant or breastfeeding, and they can be used by children as young as four. Ventolin and albuterol can also be used preventatively by people with exercise-induced asthma when used prior to exercise. In general, HFA inhalers like Ventolin and albuterol are considered safer to use and better for the environment than the CFA inhalers that were banned in 2008.
Risks and Warnings
Ventolin and albuterol can both be life-saving medications if taken properly, but there are also several warnings and risks associated with the medications. Risks and warnings associated with both albuterol and Ventolin include:
- Both medications should not be used in patients under the age of four.
- Patients should not use Ventolin HFA or albuterol inhalers without being shown how to use them properly.
- Patients should not increase their dose of Ventolin HFA or albuterol without their doctor’s approval, as people who use too much Ventolin HFA can die from abusing the medication.
- People who are allergic to albuterol sulfate should not use albuterol or Ventolin inhalers.
Because albuterol is the active ingredient in Ventolin, the side effects of the medications are virtually the same. However, patients may experience slightly different side effects when taking one drug or the other due to small differences in the chemical composition of the drugs’ inactive ingredients. Common side effects associated with Ventolin and albuterol include:
- Sore throat
- Pounding or racing heartbeat or heart palpitations
- Fast heart rate
- Upper respiratory tract infection, including viral infection
- Muscle pain
- Chest pain
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, consult your healthcare provider. Ventolin and albuterol also have serious side effects that require medical attention. Serious side effects associated with Ventolin and albuterol include:
- Worsening trouble breathing, coughing, and wheezing (paradoxical bronchospasm), which most commonly occurs with the first use of a new inhaler
- Possible death in people who use too much Ventolin
- Changes in laboratory blood values, including blood sugar and potassium
- Heart problems, including faster heart rate and higher blood pressure
- Serious allergic reactions. Signs of an allergic reaction include:
- Swelling of the face, mouth, or tongue
- Breathing problems
Both Ventolin and albuterol can interact with other prescription medications, as well as over the counter drugs, vitamins, supplements, and herbs. It is important that patients provide their doctor with a complete medication list prior to taking Ventolin or albuterol. Ventolin and albuterol may interact with the following types of medications:
- Other inhaled medications or asthma medicines
- Monoamine oxidase inhibitors (MAOIs)
- Tricyclic antidepressants
Use in Pregnant and Breastfeeding Women
Scientists have found 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. Therefore, it is impossible to predict how pregnancy will impact your asthma. However, in general, an asthma diagnosis is not a reason to avoid pregnancy. Both albuterol and Ventolin are classified as Category C medications 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. However, doctors generally recommend that women continue to use their inhalers during pregnancy because the benefits outweigh the risks. 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. Both medications are also considered safe to use while breastfeeding, but patients should always check with their doctors regarding the safety of any medications they are taking.