According to the National Institutes of Health (NIH), asthma is a chronic lung disease that causes inflammation and narrowing of the airways, leading to symptoms such as wheezing, cough, chest tightness, and shortness of breath. Asthma affects over 28 million people in the United States, approximately 1 in every 12 individuals.

Asthma treatment typically includes prescription inhalers. Inhaled corticosteroids reduce airway inflammation and help prevent asthma attacks, while bronchodilators (quick-relief inhalers) treat acute asthma attacks. However, some people look for over-the-counter (OTC) asthma inhaler options if they don’t have access to or can’t afford prescription asthma treatments.

This guide explains how OTC asthma inhalers work, how they compare to prescription inhalers, and when medical care is essential.

What Are Over-The-Counter Asthma Inhalers?

Over-the-counter asthma inhalers are short-acting bronchodilators. They contain nonselective adrenergic agonists that stimulate both alpha and beta receptors throughout the body. While they relax airway muscles to improve breathing, they can also affect other receptors in the body, increasing the risk of side effects.

OTC vs Prescription Asthma Inhalers

Active Ingredients

There are different types of prescription inhalers that are approved to treat different lung diseases, such as asthma and chronic obstructive lung disease (COPD). These include:

Inhaled corticosteroids (steroids) for long-term control of asthma symptoms, such as fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), and mometasone (Asmanex Twisthaler).
Long-acting beta agonists (LABAs) to reduce swelling in the airways for 12 hours or more, such as salmeterol (Serevent) and formoterol (Perforomist).
Combination inhalers containing corticosteroids and long-acting beta agonists, such as fluticasone and salmeterol (Advair Diskus), budesonide and formoterol (Symbicort), and vilanterol and formoterol (Breo Ellipta).
Short-acting beta agonists (SABAs) for use as rescue inhalers during asthma attacks, such as albuterol (ProAir HFA, Ventolin HFA) and levalbuterol (Xopenex HFA).

The active ingredients in over-the-counter asthma inhalers are epinephrine and racemic epinephrine, which are short-acting bronchodilators that work to widen the airway to improve airflow for easier breathing.

Some people with asthma may need to take allergy medications in addition to using inhalers.

Selectiveness of Albuterol vs Epinephrine

Albuterol is a selective beta-2 adrenergic agonist, meaning it primarily targets beta-2 receptors in the lungs to relax the airway muscle. Epinephrine is a non-selective adrenergic agonist that activates alpha- and beta-receptors throughout the body. This difference in receptor selectivity makes albuterol more effective in treating lung conditions such as asthma.

Effectiveness of Prescription vs OTC Inhalers

Research shows that prescription asthma inhalers are stronger and more effective at controlling asthma symptoms, such as wheezing and shortness of breath, and protecting the airways than OTC asthma inhalers like racemic epinephrine, even at higher doses.

OTC inhalers may help mild, intermittent symptoms, but they are not appropriate for moderate to severe asthma or frequent attacks.

Additional studies show that patients in the emergency department who received nebulized albuterol for bronchiolitis (a common lung infection in infants and young children) are more likely to be successfully discharged than those treated with nebulized epinephrine, the active ingredient in Primatene Mist, an FDA-approved OTC asthma inhaler.

Why Proper Asthma Diagnosis and Long-Term Care Matter

Asthma is a chronic (long-term) inflammatory lung condition that requires proper diagnosis and management by a healthcare provider. OTC asthma inhalers are not a replacement for prescription treatments or long-term care for preventing worsening of asthma attacks.

If you have frequent symptoms, nighttime awakenings, or more than two attacks per week, you likely need prescription therapy. A healthcare provider can create a personalized asthma action plan and prescribe appropriate maintenance and rescue inhalers.

Popular Over-The-Counter Inhalers

There are two over-the-counter asthma inhalers available in the US. Both work similarly, but one might be more effective than the other based on personal experiences. OTC asthma treatment options include:

Primatene Mist

Primatene Mist is the only OTC asthma inhaler approved by the FDA.
It contains the active ingredient epinephrine.
This OTC inhaler can provide temporary relief from mild asthma symptoms such as shortness of breath, wheezing, and chest tightness.
Primatene Mist is not FDA-approved to treat chronic obstructive pulmonary disease (COPD) or other lung conditions.
It starts working in about 20 minutes to relieve mild asthma.
It is approved for use in adults and children 12 years of age and older.
The recommended dose is 1 to 2 inhalations every 4 hours as needed.
Do not use more than eight inhalations in 24 hours.

Asthmanephrin

Asthmanephrin contains racepinephrine, a medication very similar to epinephrine.
Asthmanephrin can provide temporary relief of bronchial asthma symptoms, such as wheezing, shortness of breath, and chest tightness.
You should feel better within 20 minutes of using this over-the-counter inhaler.
You can buy Asthmanephrin without a doctor’s prescription.
It has approval for use in adults and children. Do not use it in children younger than 4 years of age without consulting a healthcare provider.
The usual dose is 1 to 3 inhalations every 3 hours as needed.
Do not exceed 12 inhalations in 24 hours.

Vicks Sinus Inhaler (Not For Asthma)

Vicks Sinus Inhaler, despite its name, is not an inhaler but rather a humidifier. It produces warm steam that can clear mucus from a stuffy nose or blocked sinuses. While you can use this product to relieve cold and flu symptoms, it does not help open tight airways in people with asthma.

Can You Buy Albuterol Without a Prescription?

Albuterol inhalers are prescription-only in the United States. However, you can get an albuterol inhaler over the counter in some countries, for example, border towns in Mexico. But the quality and expiration dates of these inhalers are suspect, and using them can put your health at serious risk.

How To Purchase and Store OTC Inhalers Safely

You can purchase an inhaler over the counter at a pharmacy, such as Walmart, Walgreens, or CVS, or order them online.

Store your over-the-counter asthma inhaler at room temperature in a cool, dry place. Do not place it near flames or heat sources (this can cause it to burst).

Keep the inhaler clean. Wash the mouthpiece with water daily to prevent clogging. Do not clean with alcohol or place the OTC inhaler in the dishwasher or washing machine.

How To Use OTC Inhalers Correctly

Activate your new OTC asthma inhaler by shaking it well and spraying it into the air 4 times. To use the inhaler:

Remove the cap and shake the inhaler.
Prime it (spray once into the air) if it's a new inhaler.
Exhale fully.
Place the inhaler in your mouth and press down on the top while inhaling deeply.
Hold your breath for as long as you can and then exhale slowly.
Wait about one minute. If your symptoms have not improved, take a second inhalation.
Wait at least 4 hours between doses for Primatene Mist and at least 3 hours between doses for Asthmanephrin.
Do not use more than eight inhalations in 24 hours for Primatene Mist and 12 inhalations in 24 hours for Asthmanephrin.

Safety and Precautions

Side Effects of OTC Inhalers

Over-the-counter asthma inhalers, such as Primatene Mist and Asthmanephrin, can cause a temporary increase in blood pressure and heart rate, which can increase the risk of heart attack, stroke, and death.

Note: Increased heart rate is a common side effect of all bronchodilator drugs, including prescription asthma inhalers. These effects are temporary and usually go away in a short time.

Drug Interactions

Do not use Primatene Mist if you are taking medications called monoamine oxidase inhibitors (MAOIs) or have taken them in the last 14 days.

Check with your doctor or pharmacist before using an over-the-counter asthma inhaler if you are taking other prescription drugs.

When To See A Doctor

Persistent or severe asthma symptoms mean that OTC asthma inhalers are not enough. Make an appointment to see your healthcare provider if:

Your symptoms do not improve within 20 minutes after taking a dose of an OTC inhaler.
Your symptoms get worse after using OTC inhalers.
You need more than eight inhalations of Primatene Mist in 24 hours.
You have more than two asthma attacks per week.
You have severe symptoms, such as difficulty breathing or chest pain.

Over-the-counter asthma inhalers can relieve mild asthma symptoms that occur intermittently. However, people who have more frequent symptoms (more than two asthma attacks a week) or severe symptoms should use prescription inhalers.

FAQs

Can I Use An OTC Inhaler Daily?

Do not use an OTC inhaler daily. OTC inhalers only treat mild asthma symptoms that occur occasionally. If you need to use an OTC inhaler daily, it means your asthma is moderate to severe. Consult a healthcare provider for proper management.

Is Primatene Mist The Same As Albuterol?

No, Primatene Mist is not the same as albuterol. It contains epinephrine, which can treat mild, intermittent asthma, but is not effective for moderate-to-severe asthma.

Is Primatene Mist A Steroid?

No, Primatene Mist is not a steroid. It is an alpha- and beta-adrenergic agonist and a short-acting bronchodilator.

Can I Buy Salbutamol Nebules Over The Counter?

No, you cannot buy salbutamol nebules, also known as albuterol nebules, over-the-counter. This is a prescription-only medicine in the U.S. for use in a portable nebulizer.