Common inhaler drug albuterol suffers severe shortage just as allergy season starts

Shortages of the common asthma drug albuterol are expected to get even worse just as a harsh pollen season arrives early.

Liquid albuterol manufacturer Akorn Pharmaceuticals has filed for bankruptcy and closed its plants in Illinois, New Jersey and New York.

This leaves only one manufacturer in the United States — South Carolina-based Nephron Pharmaceuticals — struggling to keep up with demand.

Medics are sounding the alarm, saying they are “super concerned” about the shortage of a drug that is a lifesaver for asthmatics, the elderly and the young.

It is feared that the early pollen bomb hitting the United States will put more demand on supplies for its 25 million asthma sufferers.

Stocks of the drug were deficient last fall as demand spiked amid the triple demise of Covid, flu and RSV.

Peaking pollen levels in parts of the US — up to a month ahead of schedule — raise the risk of asthma sufferers having an asthma attack.

Doctors commonly use albuterol to treat this, which works by binding to receptors in the airways, causing muscles to relax and airflow to be stimulated.

It can also be used to help open the airways of people suffering from respiratory infections, such as from Covid, or those whose airways become narrowed after exercise.

The drug is usually administered in an inhaler in an aerosol or liquid form.

But for people who have difficulty using the devices, such as babies, young children and the very sick, it is instead administered through a nebulizer.

This uses a liquid version of the drug and turns it into a fine mist, which the patients then inhaled.

This liquid version is currently in short supply. Albuterol deliveries used in inhalers are not performed.

Dr. Juanita Mora, an immunologist at the Chicago Allergy Center and spokeswoman for the American Lung Association, said doctors were “super concerned” about the shortage.

She said USA today: ‘It is a medicine to save lives and let people breathe, especially when children, the elderly and also the very sick cannot really use an inhaler.’

She explained that supply problems began last fall when “millions of children were hospitalized with respiratory infections, [all] nebulized albuterol for wheezing and coughing’.

“And then you add in long-distance covid and you have an additional population that uses it as well.”

But she said with the early onset of spring, America’s 25 million asthmatics — including 4.8 million children — were now having trouble getting the drug.

“Pollen is one of the big triggers when it comes to asthma,” she said.

So that’s the biggest concern. Liquid albuterol is sent to emergency rooms and hospitals so that the sickest patients get it.”

Southeastern states have seen trees release pollen three weeks earlier than usual this year, triggering allergy symptoms earlier than usual.

In the mid-Atlantic and northeastern states, the season started almost four weeks early.

Texas, Arkansas, Ohio, Kentucky, Maryland, New Jersey and New York have seen their earliest springs in four decades.

In asthma attacks, a misfire of the immune system against a perceived threat, such as pollen, causes inflammation that causes the airways to constrict.

The deficient drug is a 20 ml solution of 0.5 percent liquid albuterol (pictured)

This restricts airflow to the lungs and, if the airways become clogged with mucus, it stops completely – causing suffocation.

About 3,500 Americans die from these attacks each year, according to figures.

Last month, Akorn Pharmaceuticals filed for bankruptcy, closing all factories and laying off 900 workers.

Nephron Pharmaceuticals is stepping in to close the gap, with the company producing the drug “as quickly as possible to get to market — and to patients — to address this shortage.”

However, children’s hospitals report having to mix their own doses of liquid albuterol to supply the nebulizers – a time-consuming process.

There are no reports yet from major pharmacy chains of a shortage of liquid albuterol for use in nebulizers kept at home.

Walgreens told ABC it was “able to meet patient demand right now.”

Other pharmacy chains — including CVS, Rite Aid, Kroger and Albertsons — have yet to respond.

Medical professionals may also look into alternatives to liquid albuterol, including the drug levalbuterol. But this is considered less effective.

In a statement released Wednesday, the FDA said the shortage ‘affects only a very specific dosage form of the medication commonly used in hospitals’.

This is a 20 milliliter bottle of 0.5 percent concentration.

While Akorn Pharmaceuticals’ offering is listed as “unavailable,” that of the only other supplier, Nephron Pharmaceuticals, is listed as “upon allocation.”

It added: “All other strengths and vial sizes are currently available to meet market demand in hospitals and beyond.”

To solve the crisis, the FDA is considering allowing imports of the product from abroad and speeding up the approval of new suppliers.

The drug was first listed as being in October last year.

However, other experts have called for calm over the shortfall.

Dr. David Khan, the former president of the American Academy of Allergy, Asthma and Immunology, has urged Americans not to panic over the shortage.

He told ABC news“A lot of this problem is mainly, I would say, in hospitals, and they’re looking at other alternative sources for liquid albuterol.”

He added that inhalers are just as effective as nebulizers.

“I think this is a common misconception,” he said. “Patients generally just need a few more puffs from their albuterol inhaler, and it works the same as the nebulizer.”