America's shortage of asthma medication, explained

An ongoing shortage of albuterol, an asthma medication primarily used by hospitals, may be exacerbated by the recent closure of one of the country's two domestic producers of the medicine. Here's what you need to know: 

What is albuterol?

Albuterol is a medication that helps open constricted airways caused by the inflammation associated with asthma. "It works by activating the beta receptors in the lungs, which helps the airways open and relax so asthma sufferers can breathe more easily," ABC News explains. Albuterol can be administered "through an inhaler or as an aerosolized solution through a nebulizer machine." The latter type is currently facing a national shortage in the United States.  

The aerosolized solution is sometimes used at home for "infants and young children who have difficulty using an inhaler," ABC adds, but it is mainly used "in hospital settings to treat a range of breathing problems associated with wheezing that includes asthma and some respiratory infections.."

What led to the asthma medication shortage?

"Although it's not clear what prompted the initial constrained supply," ABC says the Food and Drug Administration has been tracking the shortage nationally. The agency added the medicine to its shortage list last fall. Last year's shortages "were exacerbated by outbreaks of the coronavirus and RSV," The Washington Post explains. 

In February, generic drug manufacturer Akorn Pharmaceuticals filed for bankruptcy. Then it shut down three of its facilities in March, including its Illinois facility, one of the only producers of liquid albuterol. "The shutdown of that plant leaves just one remaining domestic supplier of liquid albuterol,'" the Post adds, "although another pharmacy supplier is racing to build a second supply."

In a statement posted on Twitter, the FDA said that it's "working to address a shortage of a particular form of albuterol — a medication that is used to treat breathing conditions. It is important to note that this shortage does not impact albuterol inhalers for personal use."

Akron's closure leaves South Carolina-based Nephron Pharmaceuticals "as one of the only remaining primary manufacturers of liquid albuterol," ABC says. "We are currently producing Albuterol as fast as possible to deliver to the market — and to patients — to address this shortage," Nephron CEO Lou Kennedy told ABC.

How are health-care providers coping with the shortage?

Children's hospitals have been "deploying workarounds" since the onset of the shortage, the Post says, including looking for other suppliers and "modifying doses of albuterol in their own pharmacies to suit their needs, a process called compounding." Wholesalers have prohibited hospitals from ordering more of their usual supply of the medication to avoid hoarding, according to what Premier, a group purchasing company for hospitals, told the Post. 

The shortage has forced the staff at Nemours Children's Hospital in Orlando to "squeeze out the contents of 40 tiny 0.5 ml containers" to create a single batch, said  Angela Folger, the facility's director of pharmacy. While it is time-consuming and labor-intensive, Folger told the Post, "ultimately they have been able to find enough."

Over the past two months, the Children's Hospital Association has increased the production of "an alternative supply of liquid albuterol from a partner supplier, STAQ Pharma," the Post writes. Since STAQ is a new producer, the product's expiration date starts at just 32 days, though the plan is to extend the expiration dates as "the product proves to be safe and stable," the organization said. 

"STAQ plans to ramp up to full production by May 2023 so that hospitals have a stable supply ahead of the next respiratory season," says Mark Spiecker, president of STAQ Pharma.