The ongoing shortage of a medicine that emergency rooms and hospitals depend on for treating breathing problems will likely to get worse in the coming weeks and days experts warn.
This is because one of two main U.S. suppliers of liquid albuterol, Akorn Pharmaceuticals, abruptly cut its entire workforce and shut down factories within New Jersey, New York and Illinois in February.
“We’re only one plant that supplies albuterol in liquid form to every patient in the United States,” said Dr. Juanita Mora, a Chicago allergist/immunologist and volunteer spokesperson for the American Lung Association.
The only remaining liquid albuterol Nephron Pharmaceuticals, has faced manufacturing problems of its own, thereby aggravated the issue further the issue, according to Bayli Larson Strategic Initiatives partner of the American Society of Health-System Pharmacists (ASHP).
“Another issue that may be involved is that institutions that, in anticipation of the supply shortage, could have increased their order to ensure they have sufficient stock,” Larson added. “ASHP disapproves of hoarding as measure to prevent disruptions to supply of medications However, certain institutions believe they need to be doing it in order in order to protect patient health.”
The issue comes at the perfect timing, Mora said.
“We are getting ready to enter allergy season and pollen levels are expected to start to increase throughout all across the United States,” Mora stated. “And we’re aware of how many children and adults suffer from symptoms of allergic asthma and are beginning to notice it even in Chicago as we’ve had an extremely mild winter. There’s another asthmatic patient during the day who comes in with wheezing.”
Albuterol is a drug that affects the airways, making them dilate and improve breathing. It’s prescribed for a range types of respiratory disorders. but most typically as a treatment for asthma or COPD, Mora said.
“It’s utilized by more than 25 million asthmatics across the United States — that includes 20 million adults, 5 million children as well as 24 million people suffering from EMP or COPD, and those suffering from any respiratory illness,” Mora said. “So this lack of patients is an issue for medical professionals.”
Liquid albuterol is commonly used by emergency rooms in order to aid those suffering from severe breathing problems. It is administered via an nebulizer using a mouthpiece or mask for the face.
Many families with asthmatic children may also utilize albuterol at-home nebulizers to make breathing more easily, Mora said. There are parents who can’t find liquid albuterol, or refill it at pharmacies.
Albuterol inhalers are available and easily accessible, Mora and Larson said.
Mora recommends that all patients use their albuterol inhaler kept up to up to. Usually each canister contains 200 doses. They should last for a long period of time. It’s as effective as albuterol liquid.” Mora said.
If patients rely on inhalers at home, it can help reduce the need for inhalers in medical facilities and emergency departments, Mora said.
“I’m warning people not to attempt to fill up on liquid albuterol, and then store the liquid,” Mora said. “Let Albuterol’s liquid available reach the emergency and hospitals departments where children and adults suffer from asthma flare-ups or COPD exacerbations, or the emphysema.”
There are issues with insurance in this approach, according to Dr. Paul Williams, president-elect for the American Academy of Allergy, Asthma and Immunology.
“There are a few people who currently be affected by not having liquid albuterol. One of them is that of the Medicare population, as the liquid albuterol drug is covered by Medicare Part B, whereas the metered dose inhalers are covered by Part D,” Williams said. “So patients are required to pay out of pocket for the expenses for inhalers. I’ve often had patients who could not afford to purchase their inhalers however, they would be able to use the Nebulizer.”
It’s even more difficult to use inhalers in treating those with disabilities and infants who have breathing issues, Williams said. But I think that if we restrict the application of liquid albuterol to people who truly need it, the shortage could be a bit lessened,” Williams added.
The issue began in May, when Nephron is a company that makes generic medicines, announced an voluntary recall across the nation that included 2.1 millions doses various medicines according to the U.S. Food and Drug Administration. The company pointed to sterility concerns as the reason behind the recall.
In the month of October 2022, the FDA issued Nephron a letter of warning that outlined “significant violations” discovered during inspections from March and April 2022. Due to these manufacturing problems albuterol liquid has been placed on back orders from Nephron.
The government of the United States is currently cooperating with Nephron to boost production and boost production, Mora said. They are also looking into the possibility of the possibility of importing liquid albuterol to help the country cope with the crisis.
There are also options to replace liquid albuterol readily available to doctors, like Xopenex (levalbuterol), Mora explained.
“It’s higher priced, however it’s readily accessible in liquid and forms of inhalers So they’re working to stock up on it, also, to aid in the supply shortage,” Mora said.
In addition to having an albuterol inhaler at the go, Mora is encouraging patients to create an action plan for asthma with their physician so that they are aware of what they should do in the event in the event of an emergency.
Asthma patients should ensure that they use any other medications they’ve been given to treat their asthma, in order to lower the chance of needing treatment in the hospital or ER, Larson said.
