Albuterol, a fast-acting medication used to treat breathing problems in children, has been on the Food and Drug Administration's shortage list since October.
Akorn Pharmaceuticals filed for Chapter 7 bankruptcy in late February and closed its plants in Illinois, New Jersey and New York. Now there is only one company left in the U.S. that makes liquid albuterol: Nephron Pharmaceuticals. Liquid albuterol is used in nebulizers to help treat children who are too young to use an inhaler. (A nebulizer, in case you're not familiar with it, turns liquid medication into a mist to be inhaled.) So far, inhalers haven't been officially impacted by the shortage, although some parents have reported problems finding them.
Nephron's chief executive officer, Lou Kennedy, recently told the Washington Post that the company is making albuterol "as fast as possible" to address the shortage, but for now it persists.
That's left some parents worried. One is Mark Joseph, father to a 5-year-old and a 7-year-old from St. Louis, Mo. "My youngest has severe asthma, so albuterol is an essential medication to keep her symptoms under control," he tells Yahoo Life. "We usually rely on it for emergencies when she has trouble breathing or experiences an attack." Joseph says it's been difficult to find albuterol in his area and "even more challenging to find an alternative medication."
Instead, he says, "we have had to rely on tracking down supplies from friends and family, which is not always possible. This has caused us a lot of stress, as we always worry about having enough in an emergency."
Joseph says his family has used the alternatives levalbuterol and budesonide on their doctor's recommendation. "The alternative medications managed my child's symptoms well, but I believe they are less effective than albuterol," he says. "We continue to look for albuterol, but it has been difficult to find."
"The shortage has made me feel helpless and frustrated," he adds.
But while there's plenty of chatter on social media about the shortage, doctors say parents shouldn't panic — and that there are numerous ways to handle it.
"We have heard of patients not being able to get their albuterol at their regular pharmacies, but with a little creativity, families have been able to find it," Dr. Melanie Sue Collins, director of the cardiopulmonary lab at Connecticut Children's, tells Yahoo Life. "If it's not at one pharmacy, it may be at another."
Dr. Michael Bauer, a pediatrician and medical director at Northwestern Medicine Lake Forest Hospital, tells Yahoo Life that patients who have used albuterol in a nebulizer should be able to use an inhaler if they can't find the drug in liquid form. "Almost anyone can use an inhaler, and when used properly, it provides the same delivery of albuterol and relief of symptoms as the aerosolized form," he says. (However, he says, infants and small children will need to use a spacer device — a holding chamber that makes it easier to breathe in the medicine — and will likely need some coaching.)
If you have extra albuterol at home but the expiration date has passed, you may still be able to use it, Dr. Daniel Ganjian, a pediatrician at Providence Saint John’s Health Center in Santa Monica, Calif., tells Yahoo Life. "It's OK to use it past the expiration date for a bit," he says.
However, it's difficult to know how long it will be good for, Jamie Alan, an associate professor of pharmacology and toxicology at Michigan State University, tells Yahoo Life. "All prescriptions are labeled as being expired one year after dispensing, or less," she says. "The actual expiration date may be longer." But, she adds, "it may not be as effective" over time. If you find yourself in this situation, Alan suggests calling your child's pediatrician about next steps.
Keep in mind that there are alternatives for albuterol on the market. "Alternatives include levalbuterol (Xopenex) and albuterol/ipratropium (DuoNeb)," Dr. Ashanti Woods, a pediatrician at Mercy Family Care Physicians in Baltimore, tells Yahoo Life. "Each of these also requires a prescription from the physician."
Albuterol is a fast-acting medication that's typically used in emergency situations, and if your child is relying on it heavily, it may be time to talk to your doctor about steps you can take to get your child's breathing issues under better control, Collins says. She recommends looking into SMART therapy (which stands for Single Maintenance and Reliever Therapy), a combination of an inhaled corticosteroid and an inhaled long-acting beta-2 agonist (LABA). "It will give you much better control," Collins says. "Over time, albuterol does nothing to modify your disease and keep it under control."
Ultimately, experts say it's a good idea to touch base with your child's pediatrician or pulmonologist if you have concerns. "If your child is using albuterol more than once or twice a week, or if coughing wakes them from their sleep more than twice per week, a conversation should be had with the pediatrician to discuss if a controller medicine can help with symptoms," Woods says.
Collins agrees. "Talk to your doctor about your other options — 100%," she says.
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