As emergency departments turn to albuterol inhalers as a first-choice treatment for patients with suspected COVID-19 who have shortness of breath, the increased demand has sucked up the supply of the rescue medications used to manage asthma attacks and exacerbations of other respiratory conditions such as chronic obstructive pulmonary disease (COPD).
In addition, recommendations at the beginning of the pandemic urged patients to stock up on their medications. That could have accelerated the problem for those who did not lay in a 90-day stock of their inhalers.
Production hasn’t kept pace with the increased demand. The American Association of Health-System Pharmacists added albuterol sulfate metered-dose inhalers to its list of drugs in shortage on March 24.
Pharmacists can help patients manage their conditions through the shortage by explaining how to extend the life of patients' current inhalers and suggesting that they use a nebulizer at home.
The American College of Allergy, Asthma and Immunology (ACAAI) recommends several ways that patients with asthma, COPD, or other respiratory diseases can manage in the face of potential shortages. As a pharmacist, you can walk them through these steps to keep them from panicking.
First, check whether current and recently used inhalers still have some medicine in them. Remind patients that expired albuterol inhalers likely still provide some value.
Caution patients about overuse, as one canister should last most patients for several months. Staying on maintenance medications can reduce the need for rescue, as can avoiding situations that can trigger attacks. If a refill is not available, suggest contacting their healthcare provider to obtain another prescription or discuss other options.
Patients who have nebulizers should not be afraid to use them. Emergency departments fear that nebulizers could aerosolize the coronavirus as well as the albuterol, leading to contamination in the hospital. That’s less of an issue at home.
For greatest safety, patients who use a nebulizer should administer their treatment away from other household members and in a spot that does not recirculate air into the home. The ACAAI recommends taking nebulizer treatments in the garage or on a porch, deck, or patio. Choose spots that can be easily disinfected afterward.
Remind patients that coronavirus droplets can remain in the air for 1 to 2 hours, so it would be best to do the treatment in a space that has little traffic, even if they have no COVID-19 symptoms, because many individuals infected with the virus are asymptomatic.
