Shortage of liquid albuterol may get worse before it gets better

To conserve supplies while providing patient relief, a pulmonary expert suggests using a spacer device connected to an inhaler instead of a nebulizer

By Samantha WildowJournal-News

HAMILTON, Ohio — An ongoing national shortage of albuterol sulfate inhalation solution — the liquid version used in nebulizers for patients unable to use an inhaler, such as infants, who have breathing complications — is expected to worsen before it recovers.

The Ohio Department of Public Safety's EMS division recommended EMS and health care providers consider alternative methods of delivering care to patients, along with prioritizing use of available supplies among certain patients. Those patients include, but not limited to, infants, toddlers, and patients with tracheostomies or chronic mechanical ventilator dependency.

"It is the standard rescue medicine for children with asthma," said Dr. Daniel Evans, chief of the division of pulmonary medicine at Dayton Children's Hospital. Evans said liquid albuterol is used with nebulizers in emergency rooms or at-home machines that families use.

It has been a "perfect storm" of manufacturing issues that have led to this shortage, said Dr. Justin Coby, a Cedar Care Village pharmacist.

Akron Pharmaceuticals, one of the manufacturers of the drug, closed and filed bankruptcy last month. Another manufacturer, Nephron Pharmaceuticals, also is recovering from a recall it did last year, citing sterility issues.

"The remaining manufacturers have focused their efforts on getting the product to hospitals versus community-based health care," Coby said.

While supplies for nebulizers may be limited, doctors have other methods of getting albuterol to patients, Evans said. A spacer device can be connected to an inhaler, which are not in a shortage, in order to breathe in the medicine more easily and waste less medicine than with just an inhaler.

If done correctly, Evans said using a spacer with an inhaler is just as effective as using a nebulizer.

"It's quicker, and it's portable," Evans said.

Evans said he still considers this shortage of liquid albuterol to be "very urgent" as some patients cannot use those devices and do better with a nebulizer, saying they are still at a "crisis level."

"We are getting a shortage here at the hospital," Evans said. Dayton Children's Hospital has a couple months worth of supplies available, he said.

"It's such a prevalent medication used by a number of people, all of the reserves are going to be taken up soon," Evans said. "I'm anticipating this is probably going to get a little worse before it gets better."

Parents should not try to ration their children's albuterol for their nebulizers, Evans said. He said parents should continue to follow their child's asthma action plan or talk to their doctors about potentially converting to an inhaler with a spacer device.

"Ultimately we want them to be able to stay well," Evans said.

Parents also should make sure their children are using their controller medications for asthma and allergies to prevent and control their symptoms.

"Those are the medications that decrease the need for albuterol," Evans said.

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