By Dennis Thompson
health day reporter
THURSDAY, March 9, 2023 (HealthDay News) — Ongoing shortages of a drug that hospitals and emergency rooms rely on to treat respiratory problems are likely to worsen in the days and weeks ahead, experts warn.
Indeed, one of the two main American suppliers of liquid albuterol, Akorn Pharmaceuticals, abruptly laid off its entire workforce and closed factories in New Jersey, New York and Illinois at the end of February.
“We’re reduced to one factory that supplies liquid albuterol to every patient in the United States,” said Dr. Juanita Mora, a Chicago allergist/immunologist and volunteer spokesperson for the American Lung Association.
That remaining liquid albuterol supplier, Nephron Pharmaceuticals, had its own manufacturing issues, making the situation even worse, said Bayli Larson, a Strategic Initiatives associate with the American Society of Health-System Pharmacists (ASHP).
“Another phenomenon that could be at play is that institutions, anticipating the shortage, may have increased their orders to ensure they had enough,” Larson added. “ASHP discourages hoarding as a countermeasure to drug supply disruptions; however, some facilities feel they must do so to avoid compromising patient care.
The shortage comes at an extremely inopportune time, Mora said.
“We are about to enter allergic asthma season, where pollen levels will start to rise across the United States,” Mora said. “And we know so many children and adults have allergic asthma symptoms and are already starting to see it now, even here in Chicago, because we’ve had such a mild winter. I have a second person with asthma from the day today that has wheezing.
Albuterol works on the airways by helping them to expand to improve breathing. It’s used for a variety of respiratory conditions, most commonly asthma and COPD, Mora said.
“It is used by 25 million asthmatics in the United States – including 20 million adults and 5 million children – and 24 million people with COPD or emphysema, as well as anyone with a respiratory disease,” Mora said. “So this shortage is definitely concerning for the medical community.”
Liquid albuterol is typically used by emergency rooms to help people who have a serious breathing problem. The drug is delivered from a nebulizer through a mouthpiece or face mask.
Some families with children with asthma also use liquid albuterol in household nebulizers to help children breathe better, Mora said. She has already heard of parents unable to find liquid albuterol or restock it at the pharmacy.
However, albuterol inhalers are in stock and readily available, Mora and Larson said.
Mora recommends that all of his patients have their albuterol inhaler up to date and up to date.
“Usually each of the canisters contains 200 doses. This should wear them for a long time. It works just as well as liquid albuterol,” Mora said.
If people rely on inhalers at home, that will help ease shortages in hospitals and emergency rooms, Mora said.
“I tell people not to go ahead and try to fill liquid albuterol and store it,” Mora said. “Leave albuterol liquid currently available in hospitals and emergency departments where children and adults go with exacerbations of asthma or exacerbations of COPD or emphysema.”
But there are insurance issues with that approach, said Dr. Paul Williams, president-elect of the American Academy of Allergy, Asthma and Immunology.
“There are certain populations that currently will likely suffer from not having liquid albuterol. One is the Medicare population, because currently liquid albuterol is covered under Medicare Part B, while metered-dose inhalers are covered by Part D,” Williams said. “So patients have out-of-pocket expenses associated with inhalers. I often had patients who couldn’t afford their inhalers, but would do well with the nebulizer .
It’s also more difficult to use inhalers to treat infants and disabled people with breathing problems, Williams said.
“But I think if we limit the use of liquid albuterol to populations that really need it, that shortage can be alleviated to some degree,” Williams added.
The problems began last May when Nephron, which manufactures generics, issued a voluntary national recall of 2.1 million doses of various drugs, according to the United States Food and Drug Administration. The company cited infertility issues as the reason for the recall.
In October 2022, the FDA sent Nephron a warning letter summarizing “significant violations” found during inspections from March to April 2022. Due to these manufacturing issues, liquid albuterol is out of stock at Nephron .
The federal government is now working with Nephron to ramp up production and increase supply, Mora said. It is also considering importing foreign supplies of liquid albuterol to help the country overcome the shortage.
There are also alternatives to liquid albuterol available to doctors, such as Xopenex (levalbuterol), Mora said.
“It’s more expensive, but it’s also available in liquid and inhaler form, so they’re also trying to increase stock to help with the shortage,” Mora said.
Along with having an albuterol inhaler on hand, Mora encourages patients to work out an asthma action plan with their doctor so they know what to do in an emergency.
Asthma patients should also ensure they are taking all other medications they have been prescribed to control their condition faithfully, to reduce the risk of them needing treatment in a hospital or emergency room, said Larson.
The American Lung Association says more about lung health and disease.
SOURCES: Juanita Mora, MD, Chicago allergist/immunologist and volunteer spokesperson, American Lung Association; Bayli Larson, PharmD, Strategic Initiatives Associate, American Society of Health-System Pharmacists; Paul Williams, MD, President-Elect, American Academy of Allergy, Asthma and Immunology