Dr. Larry Chiaramonte and Dr. Paul Ehrlich
(The FDA is counting down to the end of the year when Primatene is to be pulled from the market because of the propellant, chlorofluorocarbons, or CFCs, used, which are deemed harmful to the ozone layer. We were reminded on this when a notice came up on one of the many news feeds we follow, so we thought that we would share material on this “trailing edge medicine” from our book, Asthma Allergies Children: a parent’s guide.)
Who hasn’t heard of Primatene? This is the oldest asthma inhaler. It has been advertised on television and the radio for decades, and it is currently a prominent sponsor of after-midnight programming, complete with celebrity endorsers. But do these athletes actually use the stuff, assuming they have asthma? Not if their team physicians have anything to do with it, because the active ingredients don’t just affect the lungs, they stimulate the heart. They have both beta-2, which works on the lungs, and beta-1, which works on the heart, whereas the most common rescue inhaler we use, albuterol, is specific for the lungs. As urban pediatric allergists, this specific form of self-medication worries us a great deal.
The primacy of Primatene in a poor neighborhood should surprise no one. If an upper-middle class person walks through a poor neighborhood, they will see things that have long since disappeared from their own environs: Billboards that advertise menthol cigarettes, malt liquor, and brandy are regular sights. Quick fixes to get people over life’s big problems.
The same is true with some trailing-edge medications—medications whose limitations are well known but are so cheap to produce that it’s still worth it to the manufacturers to keep them on the market.
A few years ago, I was consulting with a group in Hunts Point in the Bronx, a poor, substantially Puerto Rican neighborhood in what we call a high-asthma corridor. I walked past a playground and saw a number of small children playing with Primatene inhalers.
I asked our program coordinator if he knew why this was. He answered, “Doctor, it’s because it’s the easiest and cheapest way for their parents to deal with their asthma. They give them the inhaler and send them to school so they can go to work.” — Dr. Ehrlich
(Note: The disappearance of Primatene from the market begs the question: what will working poor families do now to help their children function so they can go to work? We urge everyone to support more asthma education and compliance programs.)