Liquid Albuterol Shortages Exacerbated by Supply Chain Issues

Last month, WAND reported that Akorn Pharmaceuticals, a major domestic manufacturer of liquid albuterol, was shutting down. This closure — which followed 2020 reports that the company filed for Chapter 11 bankruptcy — means supply chain issues will further exacerbate existing liquid albuterol shortages, leaving pediatric hospitals struggling amidst rising asthma rates.

As of March 1, 2023, the American Society of Hospital Pharmacists (ASHP) has reported nine shortages of albuterol inhalation solutions, including the now-discontinued solution from Akorn pharmaceuticals.

ASHP has researched reasons for the shortage, citing that the Akorn closure in February 2023 and the solution shortage reported by Nephron Pharmaceuticals are the main drivers of this shortage. However, Sun Pharmaceutical Industries and Mylan have yet to explain the scarcity of their products.

Albuterol is one of the main medications used to treat asthma and other lung diseases. The CDC estimates that roughly 25 million people in the United States have asthma. The organization also notes that asthma rates are rising each year.

Many experts attribute rising asthma rates to poor air quality, pollution, and other environmental exposures. A recent study published in the International Journal of Environmental Research and Public Health discovered that nearly 13% of pediatric asthma cases are linked to exposure to toxic chemicals from gas stoves. The data provided was so significant that the US Product Safety Commission leader, Richard Trumka Jr, is considering banning or regulating gas stoves.

Beyond that, an NIH study published in the Lancet Planetary Health found a link between air pollution and asthma. The study determined that increased PM2.5 and O3 concentrations found in urban communities correlated with higher rates of asthma attacks. The rising asthma rates necessitate effective treatment options and solutions.

According to an article published in CNN Health, Akorn was the only domestic manufacturer of a liquid albuterol solution used for nebulizer treatments in pediatric hospitals. With no chance that the company will resume manufacturing, pediatric hospitals are looking for alternative solutions.

Pediatric hospitals have been disproportionately affected by the rising rates of illness in recent years. Most recently, the tripledemic — a rise in COVID, influenza, and RSV rates — contributed to a shortage in hospital beds, over-the-counter pain medications, Tamiflu, and other prescription drugs. However, CNN reported that these healthcare facilities have become resilient and resourceful, using alternative bronchodilators or squeezing out medicine from smaller packages.

The ASPH notes that, currently, Mylan has an available albuterol sulfate solution in 0.083% 3 mL (2.5 mg) dosages. Nephron Pharmaceuticals also estimates that it will resume supplying albuterol throughout this month.

Although these current shortages have not severely impacted people as they did during the height of the COVID pandemic, the ongoing shortages have highlighted significant supply chain issues across the US. Additional protocols are needed to manage the problems in the pharmaceutical supply chain.