Nationwide shortage of asthma drug albuterol may worsen in hospitals

A nationwide shortage of the asthma drug albuterol has been ongoing since last fall, and experts fear it is only expected to get worse.

Albuterol can be taken in several forms, but it is the aerosolized solution used in a nebulizer in hospitals that the US Food and Drug Administration put on its drug shortage list in late October. This shortage poses the biggest challenge for hospital settings where it is used the most, but can be a problem for those who use this form of the drug at home.

This deficiency only affects a very specific dosage form of the medicine commonly used in hospitals. The FDA says it has “worked closely with manufacturers and others in the supply chain for several months to understand, mitigate, and prevent or reduce any related impacts.”

Although it is not clear what prompted the initial limited supply, the FDA has tracked the shortage.

Generic drugmaker Akorn Pharmaceuticals filed for Chapter 7 bankruptcy last month, according to documents seen by ABC News, reportedly closing its U.S. facilities and spinning off a maker of albuterol.

The FDA updated its drug shortage page on March 1 to show that Akorn’s albuterol inhalation solution is “not available” due to “no new manufacture of the product.”

This leaves Nephron Pharmaceuticals, based in South Carolina, as one of the only remaining primary manufacturers of liquid albuterol.

“We are currently producing Albuterol as quickly as possible to deliver to the market — and to patients — to meet this shortage,” Nephron CEO Lou Kennedy told ABC News.

In a announcement published online Wednesday evening, the FDA said in part that it is “working to address a shortage of a certain form of albuterol — a medication used to treat breathing disorders. It is important to note that this shortage does not affect albuterol inhalers for personal use.”

“We recognize the potential impact that intermittent availability of certain drug products can have on providers and patients. To help meet demand, the FDA has reiterated that outsourcing facilities can augment the specific product in short supply to help increase the tender,” it continued in part. . “FDA continues to explore all available regulatory actions to help secure supply — including exercising discretion for potential temporary importation from foreign suppliers.”

Local pharmacies said they have struggled to stock albuterol over the past few months and are concerned that the closing of Akorn facilities will make it more difficult.

“Albuterol solution has been in short supply for some time. It’s hard to get it in stock,” Jim Stage, owner of Lloyd Pharmacy in Saint Paul, Minnesota, and a pharmacist, told local ABC affiliate KSTP. “We check secondary and tertiary suppliers if our primary supplier doesn’t have it, so it just creates a little more legwork on our end.”

What is albuterol?

Asthma is an inflammatory disease that causes the airways in the lungs to constrict and prevent normal breathing. It affects more than 25 million Americans, according to the Centers for Disease Control and Prevention.

Albuterol is a medication that helps open up these narrowed airways. It works by activating the beta receptors in the lungs, which help the airways to open and relax so that asthma patients can breathe more easily.

Inhaled albuterol can be given through an inhaler or as an aerosolized solution through a nebulizer. The aerosolized solution is the type currently facing a national shortage.

This solution is sometimes used at home for infants and toddlers who have difficulty using an inhaler, but it is most often used in hospitals to treat a variety of breathing problems associated with wheezing, including asthma and some respiratory infections.

“This is a life-saving medicine that we need to have on demand and available when patients need it,” said Dr. Juanita Mora, national volunteer medical spokesperson for the American Lung Association, told ABC News.

Mora said she has witnessed how distressing this shortage has been for her patients and families, and warned that pollen season is right around the corner.

“As the pollen levels go up, they’re a huge trigger for asthma. I want to make sure everyone’s asthma COPD emphysema COVID-19 is well optimized before we go into that season,” Mora said.

Are there alternatives?

“Don’t panic,” said Dr. David Khan, past president of the American Academy of Allergy, Asthma & Immunology, to ABC News. “A lot of this problem is primarily, I would say, among hospitals, and they’re looking at other alternative sources of liquid albuterol.”

Khan explained that the albuterol inhalers are just as effective as nebulized albuterol, adding, “I think that’s a common misconception. Patients generally need to use a little more puffs of their Albuterol inhaler and it will work in the same way as nebulizer machine.”

For hospitalized patients or infants who cannot use an inhaler, an alternative medication to albuterol is levalbuterol.

Although similar, studies have had mixed results. A 2003 study found that replacing levalbuterol with albuterol in the emergency department “significantly reduced the number of admissions.”

However, a 2013 meta-analysis found that levalbuterol was not “superior” to albuterol in terms of efficacy and safety, and suggested not using it over albuterol for acute asthma.

It’s unclear whether every day Americans have trouble filling prescriptions. A spokesperson for Walgreens told ABC News that it is “able to meet patient demand/needs at this time.”

Other drugstore chains including CVS Health, Rite Aid Corp., Kroger Inc. and Albertsons Inc. did not return ABC News’ request for comment.

How are asthma attacks prevented?

People with lung diseases such as asthma or COPD may have more serious complications from respiratory viruses and pneumonia. To prevent these diseases, experts say to stay up-to-date on all vaccines, including Covid-19 boosters and annual flu vaccinations, and to practice good hand washing.

It is also important to know and avoid asthma triggers. Each person’s trigger may be different, but common triggers include seasonal allergies, carpets, pets, mold and tobacco smoke, according to the CDC.

When using an inhaler, proper technique is very important. The American Lung Association says people should make sure they always use a spacer with an inhaler.

If you use albuterol often, talk to your doctor about daily medications that help control asthma symptoms in addition to albuterol.

Mora urged people not to panic or hoard liquid albuterol because they are afraid of the shortage, and says doctors are asking the FDA to act immediately to address this problem.

“We urge the FDA to get on top of this problem before it becomes catastrophic,” Mora said.

ABC News’ Sony Salzman and Karen Travers contributed to this report.

Asthma is an inflammatory disease that causes the airways in the lungs to constrict and prevent normal breathing. It affects more than 25 million Americans, according to the Centers for Disease Control and Prevention.

Albuterol is a medication that helps open up these narrowed airways. It works by activating the beta receptors in the lungs, which help the airways to open and relax so that asthma patients can breathe more easily.

Inhaled albuterol can be given through an inhaler or as an aerosolized solution through a nebulizer. The aerosolized solution is the type currently facing a national shortage.

This solution is sometimes used at home for infants and toddlers who have difficulty using an inhaler, but it is most often used in hospitals to treat a variety of breathing problems associated with wheezing, including asthma and some respiratory infections.

“This is a life-saving medicine that we need to have on demand and available when patients need it,” said Dr. Juanita Mora, national volunteer medical spokesperson for the American Lung Association, told ABC News.

Mora said she has witnessed how distressing this shortage has been for her patients and families, and warned that pollen season is right around the corner.

“As the pollen levels go up, they’re a huge trigger for asthma. I want to make sure everyone’s asthma COPD emphysema COVID-19 is well optimized before we go into that season,” Mora said.

Are there alternatives?

“Don’t panic,” said Dr. David Khan, past president of the American Academy of Allergy, Asthma & Immunology, to ABC News. “A lot of this problem is primarily, I would say, among hospitals, and they’re looking at other alternative sources of liquid albuterol.”

Khan explained that the albuterol inhalers are just as effective as nebulized albuterol, adding, “I think that’s a common misconception. Patients generally need to use a little more puffs of their Albuterol inhaler and it will work in the same way as nebulizer machine.”

For hospitalized patients or infants who cannot use an inhaler, an alternative medication to albuterol is levalbuterol.

Although similar, studies have had mixed results. A 2003 study found that replacing levalbuterol with albuterol in the emergency department “significantly reduced the number of admissions.”

However, a 2013 meta-analysis found that levalbuterol was not “superior” to albuterol in terms of efficacy and safety, and suggested not using it over albuterol for acute asthma.

It’s unclear whether every day Americans have trouble filling prescriptions. A spokesperson for Walgreens told ABC News that it is “able to meet patient demand/needs at this time.”

Other drugstore chains including CVS Health, Rite Aid Corp., Kroger Inc. and Albertsons Inc. did not return ABC News’ request for comment.

How are asthma attacks prevented?

People with lung diseases such as asthma or COPD may have more serious complications from respiratory viruses and pneumonia. To prevent these diseases, experts say to stay up-to-date on all vaccines, including Covid-19 boosters and annual flu vaccinations, and to practice good hand washing.

It is also important to know and avoid asthma triggers. Each person’s trigger may be different, but common triggers include seasonal allergies, carpets, pets, mold and tobacco smoke, according to the CDC.

When using an inhaler, proper technique is very important. The American Lung Association says people should make sure they always use a spacer with an inhaler.

If you use albuterol often, talk to your doctor about daily medications that help control asthma symptoms in addition to albuterol.

Mora urged people not to panic or hoard liquid albuterol because they are afraid of the shortage, and says doctors are asking the FDA to act immediately to address this problem.

“We urge the FDA to get on top of this problem before it becomes catastrophic,” Mora said.

ABC News’ Sony Salzman and Karen Travers contributed to this report.

It is also important to know and avoid asthma triggers. Each person’s trigger may be different, but common triggers include seasonal allergies, carpets, pets, mold and tobacco smoke, according to the CDC.

When using an inhaler, proper technique is very important. The American Lung Association says people should make sure they always use a spacer with an inhaler.

If you use albuterol often, talk to your doctor about daily medications that help control asthma symptoms in addition to albuterol.

Mora urged people not to panic or hoard liquid albuterol because they are afraid of the shortage, and says doctors are asking the FDA to act immediately to address this problem.

“We urge the FDA to get on top of this problem before it becomes catastrophic,” Mora said.

ABC News’ Sony Salzman and Karen Travers contributed to this report.

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