Asthma Inhaler Abuse: A Disturbing New Trend?

Vol. 14 •Issue 3 • Page 50
Asthma Inhaler Abuse: A Disturbing New Trend?

Patients Who Take Extra Puffs May Be at Risk for Other Problem Behaviors

Drink a cup of coffee. Then another. Then another. And keep going.

Guzzle down about 10 cups and see how you feel.

Not that great, right?

Well, that’s comparable to taking 20 puffs of a prescription asthma inhaler – a dangerous way that teens are trying to get high.

“Your heart would be racing. Your hands would be trembling. Your blood pressure would rise,” said Joseph Rosman, MD, chief of pulmonary and critical care at Mount Sinai Hospital, Chicago. “I can’t fathom why people would want to feel that way.”

He’s not alone. Little research exists on the youth abuse of asthma inhalers and how big of a problem it really is.

“What’s so interesting is this isn’t on anybody’s radar screen,” said Carol J. Boyd, MSN, PhD, RN, director of the Substance Abuse Research Center, University of Michigan, Ann Arbor. Dr. Boyd recently completed a pilot study that she hopes will begin to expose the issue.

The research, published last year in the Journal of Adolescent Health, found that 15 percent of eighth- and ninth-graders from a Detroit-area public school district used a nonprescribed asthma inhaler.1 Plus, these students were significantly more likely to smoke cigarettes and marijuana, binge drink, and use ecstasy and cocaine, compared to other high school students.

“We didn’t think we would find this,” Dr. Boyd said. “This was just kind of serendipitous. Initially, when we looked at it, we thought this is a little weird that kids are acknowledging that they’re abusing asthma inhalers. Then, we saw that it was correlated with other problem behaviors related to substance abuse. That’s when that little red flag came up, and we thought we should publish this.”

The researchers, though, acknowledge some limitations.1 For starters, they had a relatively small sample size (496 eighth- and ninth-graders), and they didn’t differentiate between beta-agonists and corticosteroid inhalers, which have different pharmacological mechanisms. However, the students most likely used short-acting medication because it’s more common.

Also, the investigators didn’t define the abuse, explained study co-author Christian J. Teter, PharmD, BCPP, assistant professor of pharmacy practice, Northeastern University School of Pharmacy, Boston.

“We don’t know if every once in a while they’re playing around and want to be all jazzed up. We don’t know if they’re using inhalers therapeutically, but just off-label use – like, ‘You have an inhaler. I don’t have mine. Let me use yours,'” he said. “This is still inappropriate because there are different types of inhalers with different therapeutic effects, which could be dangerous if a student uses the wrong inhaler in an emergency situation.”

Other researchers share their concerns. Matthew Howard, PhD, professor of social work and psychiatry at the University of Michigan, surveyed 193 incarcerated youth in Missouri diagnosed with asthma.2 Of the 90 percent prescribed an inhaler, 26 percent had abused it (defined here as excessive use).

The abuse took several forms: Sixty percent did it to treat their own symptoms, 60 percent wanted to see what it would feel like, and 57 percent wanted to get high. (Subjects could answer more than once.)

“I was really shocked,” Dr. Howard said. “It’s a virtually unknown form of substance abuse.”

He interviewed young asthmatics who took extra puffs on hundreds of occasions. “Some used them to the point of passing out.”

Nausea, headache, vomiting and fatigue made the list of the short-term effects the abusers frequently experienced.

“Subjectively,” Dr. Howard said, “they didn’t seem too terribly concerned.”

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