Rupal Patel, PharmD Mary Bridgeman, PharmD
Case 1—OTC Asthma Control
LM is a 38-year-old woman who suffers from asthma and comes into the pharmacy to purchase an OTC epinephrine inhaler (Primatene Mist). She states that she has been using this type of inhaler for 10 years to control her asthma. LM also says that she was diagnosed with asthma as a child but she rarely has symptoms. She used her last few puffs last week when she participated in a 5K fund-raiser walk. Although she never has symptoms at night, LM describes needing to use 1 to 2 puffs of Primatene Mist to alleviate chest tightness approximately once a month if she exerts herself or participates in rigorous exercise. What recommendations would you make to LM about her asthma and her use of Primatene Mist?
It is important to educate patients who use Primatene Mist to follow up with a health care professional to be officially evaluated for and, if appropriate, diagnosed with asthma. LM states she was diagnosed with asthma but rarely has symptoms. The FDA approved Primatene Mist for the temporary relief of occasional symptoms of mild asthma. Therefore, LM would be a candidate for using Primatene Mist based on the frequency of her reported asthma symptoms.
However, is very important to tell LM that the only OTC asthma inhaler sold in the United States will no longer be available after December 31, 2011, as part of a phaseout of epinephrine inhalers containing chlorofluorocarbons (CFCs).1 Primatene Mist uses CFCs as a propellant to move the medicine out of the inhaler so that patients can breathe the medicine into their lungs. Pharmacists should urge those who currently use Primatene Mist to see a health care professional now to switch to another asthma medicine before shortness of breath occurs when Primatene Mist is no longer available.
Case 2—Cough and Cold Relief for Children
NM comes to the pharmacy looking for grape-flavored Triaminic syrup. He says the medication is for his 1-year-old daughter, who has been coughing all day and night for the past few days. She just celebrated her first birthday 4 days ago and caught a horrible cough from one of the other children at her birthday party. LM says the cough is keeping her up all night, which in turn is keeping him up all night. He says she needs to sleep so he can function at work. LM states that his daughter weighs 22 lb and is 30 inches. She takes fluoride vitamin drops every day but no other medications, and has no chronic medical conditions. She has no fever associated with this cough and no other symptoms. Her parents have not tried anything for cough relief, but NM remembers using Triaminic syrup for his older son a few years ago and says that it helped relieve his symptoms immediately. He wants to pick some up for her but can’t seem to find it in the OTC aisle. What are your recommendations about which product NM should purchase at this time?
Because cough and cold medications are no longer recommended for infants and children younger than 2 years due to safety risks of these agents when used in this population, nonpharmacologic methods for cough relief should be employed. Because most coughs are associated with postnasal drip, consider recommending that NM try to keep his daughter’s nasal passages clear. NM can use saline drops with a nasal bulb syringe to clear his daughter’s nose to reduce postnasal drip. He should use 2 to 6 drops in each nostril as needed. During the evening and overnight, NM can put a pillow under his daughter’s mattress or prop her up a little to help drain the postnasal drip, as sleeping upright can sometimes decrease postnasal drip. If NM or his daughter cannot tolerate the cough, it is recommended they see a pediatrician for further evaluation and pharmacologic therapy. PT
Dr. Mansukhani is a clinical pharmacist in South Plainfield, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University. Dr. Bridgeman is an internal medicine clinical pharmacist in Trenton, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University.
1.US Food and Drug Administration. FDA: over-the-counter asthma inhalers containing chloroflouorocarbons (CFCs) will no longer be made or sold after Dec. 31, 2011. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm272872.htm. Accessed October 18, 2011.