Medication Shortages
Medication shortages in the U.S. are not new. Between 2001 and 2022, for instance, an average of 135 medications per year have had a shortage and impacted patient care. The latest American Society of Health System Pharmacists (ASHP) information provided below shows the recent trends with the worst shortages in 2011 and 2004 being the year with the least (Figure 1).1 Following the COVID-19 pandemic, medication shortages have been in the triple digits – yet the recent shortages of liquid albuterol has many worried about the possible outcomes. Surprisingly, this isn’t the first time albuterol has had shortages since the beginning of the pandemic.2
What is Albuterol?
Albuterol sulfate is a short acting sympathomimetic medication that stimulates the beta2 adrenergic receptors in the lungs and beta1 adrenergic receptors in the heart. It is these beta2 properties that are most sought after in that this creates the smooth bronchial muscles to relax and help open the patient’s airway. Furthermore, it relieves bronchospasms and reduces the inflammatory response in mast cells.
Where is the Problem Being Seen?
The focused areas of interest in dealing with this shortage appears to be hospitals and EMS services given their wide use of the liquid version of the medication.3 This has garnered so much attention that some states have been issuing directive to hospital and EMS agencies alike.4 Hand-held metered dose inhalers (MDI) are not experiencing the shortage at this time and patients whose condition is less sever can typically manage their conditions with these devices. Patients whose symptoms are much more severe and have been unable to relieve their condition with this type of delivery system will require continuous hand held or nebulizing masks for their treatments. Thus, the shortage will have a more profound impact given that they are of course the most at risk given the level of care required and the severity of their condition.
Why are Shortages Occurring?
During the COVID-19 pandemic and its mutations, respiratory complications were common, and the FDA quickly and continuously recommended the use of albuterol in dealing with these respiratory issues.5 With over 58% of patients with COVID-19 who were hospitalized suffering from subsequent respiratory tract infections, the impact of COVID-19 on the supply of albuterol were significant and continue today.6 Further complicating the use of albuterol during the COVID-19 pandemic was the considerable “off-label” use and the “just in case” use of the medication.7 Additionally, factoring in a very active RSV and flu season and the strain on available resources has been significant.8
The other issue that is currently impacting the supply of albuterol are supply chain issues. The most common of those issues deals with the Akorn Pharmaceuticals filing for bankruptcy in February 2023 and Nephron Pharmaceuticals still dealing with a medical recall in 2022 over sterility quality-control issues.3
Alternative Meds
During this difficult time, it has been suggested that alternative medication such as Levalbuterol be used in the place of albuterol with some success being found in this alternative.9 Other suggest a more careful approach to the historically aggressive use of albuterol.10 Lastly, recommendations are for patients and caregivers to ensure that “controller medications” for conditions like allergies and asthma be routinely used to better control the symptoms.3 Through a more graduated approach to respiratory ailments in general and ensuring compliance of current alternative medication, this shortage will have a limited impact on patients in the U.S. in the future.
References
1. Rxpharmacist.com. How Pharmacists Navigate Through Drug Shortages: An Overview. [Internet]. 2023 [cited: 2023 Mar 27]. Available from: https://rxpharmacist.com/category/education/blog/page/2/
2. Piatek, O. I., Ning, J. C. M., & Touchette, D. R. (2020). National drug shortages worsen during COVID-19 crisis: proposal for a comprehensive model to monitor and address critical drug shortages. American Journal of Health-System Pharmacy, 77(21), 1778-1785.Zajac, D., & Team, R. How Pharmacists Navigate Through Drug Shortages: An Overview.
3. Wildow, S. Shortage of liquid albuterol continues to impact area patients, hospitals. Dayton Daily News. [Internet] 2023 March 23. [cited 2023 March 27]. Available from: https://www.daytondailynews.com/community/shortage-of-liquid-albuterol-continues-to-impact-area-patients-hospitals/IFBZN5YSZZGI7IBC6XMLTJMECE/
4. Pharmacy.ohio.gov. Albuterol Shortage and Emergency Medical Services. 2023 [cited 2023 Mar 27]. Available from: https://www.pharmacy.ohio.gov/documents/pubs/special/drugshortages/albuterol%20shortage%20and%20emergency%20medical%20services.pdf
5. FDA.gov. Coronavirus (COVID-19) Update: June 4, 2021. 2021, Jun 4. [cited 2023 Mar 27]. Available from: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-june-4-2021
6. Jakubec P, Fišerová K, Genzor S, Kolář M. Pulmonary Complications after COVID-19. Life (Basel). 2022 Feb 28;12(3):357. doi: 10.3390/life12030357. PMID: 35330108; PMCID: PMC8955291.
7. Hendeles, L., & Prabhakaran, S. (2020, December 16). Nationwide shortage of albuterol inhalers and off-label use in covid-19 … Pediatric Allergy, Immunology, and Pulmonology Vol. 33, No. 4. Retrieved March 22, 2023, from https://www.liebertpub.com/doi/abs/10.1089/ped.2020.1300
8. Christensen, J. A shortage of albuterol is about to get worse, especially in hospitals. CNN. [Internet]. 2023 Mar 3. [cited 2023 Mar 27]. Available from: https://www.cnn.com/2023/03/03/health/albuterol-shortage/index.html
9. Carl, J. C., Qureshi, F., Nowak, R., Gumbhir-Shah, K., Templeton, A. G., Baramki, D., Perrin-Fayolle, M., Sears, M. R., Page, C. P., Masoli, M., & Akinbami, L. J. (2012, November 30). Levalbuterol versus albuterol for acute asthma: A systematic review and meta-analysis. Pulmonary Pharmacology & Therapeutics. Retrieved March 22, 2023, from https://www.sciencedirect.com/science/article/abs/pii/S109455391200171X
10. Snider, M. The latest drug shortage: Albuterol. Here’s why the medical community is ‘super concerned’. USA Today [Internet]. 2023 Mar 9. [cited 2023 Mar 27]. Available from: https://www.usatoday.com/story/news/health/2023/03/09/albuterol-shortage-respiratory-drug-supply-low/11429590002/
EMS Subject Expert/Strategist for Clarion Events Fire & Rescue Group. Servant Leader, Professional Educator, Author, and Textbook Contributor. Critical Care EMT- Paramedic and Nationally Registered Paramedic, with an Associate Degree in Emergency Medical Science, a Bachelor’s in Health Science and EMS Management, a Master’s Degree in Education with doctoral-level work as part of an Education Specialist Degree and in Dissertation phase for Doctorate in Education. Background includes EMS educator with over 20 years of experience in both on site and online programs, EMS shift supervisor, field training officer and team leader, over 20 years of field paramedic and six years of critical care transport experience along with seven years of military experience in a leadership position with rapid-deployments units.
