Factory shutdown raises concern over finding asthma medication

Albuterol, vital for treatment of breathing problems, has been in short supply since last year

NEW YORK — U.S. hospitals, already dealing with a shortage of a drug vital for treatment of breathing problems, fear the closure last week of a major supplier will make the scarcity even worse.

There has been a shortage of liquid albuterol since last year, according to the American Society of Health-System Pharmacists. It has been on the U.S. Food and Drug Administration’s shortages list since October.

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Akorn Operating Co. LLC, a generic drug maker, filed for Chapter 7 bankruptcy last month and closed production facilities in New Jersey, New York and Illinois.

The company’s Illinois factory was licensed to produce liquid albuterol used in nebulizers, a type of medical device that converts the respiratory medication into a mist that can be inhaled, CBS News reported.

That raised concern among some doctors who work with patients with breathing problems such as asthma.

“This is definitely concerning, especially as we are coming out of the respiratory season where we had a big demand with RSV, COVID-19 and flu, and are now heading into spring allergy season when a lot of kids and adults experience asthma symptoms,” Dr. Juanita Mora, a national volunteer medical spokesperson for the American Lung Association and an allergist/immunologist based in Chicago, told CNN. “This is a life-saving drug and being able to breathe is vital for everyone.”

February’s unusually warm weather hasn’t made breathing easier, causing pollen season to arrive early. In Atlanta last week, the “pollen count was in the high range at 1,112, according to Atlanta Allergy and Asthma. Last year, the city didn’t hit that mark until March 30, when the count was 2,431,” the AJC’s Alexis Stevens reported.

According to Channel 2 Action News Chief Meteorologist Brad Nitz, counts that high typically last until the second half of May, and the extremely high counts — 1,500 and up — usually occur from mid-March through mid-April.

Akorn was the only company making certain albuterol products used for continuous nebulizer treatment — a staple in children’s hospitals. But the company had been out of stock since last fall, forcing hospitals to find alternatives.

“Members are either forced to compound it themselves to make the product or go to an outside third-party source who is compounding the product,” Paula Gurz, senior director of pharmacy contracting with Premier Inc., a major group purchasing company for hospitals, told CNN.

Health system leaders told The Washington Post it is another example of the fragile domestic supply of vital generic drugs. The problem was exacerbated by the pandemic and continues in multiple types of medicines. Profit margins are so low on some generic drugs that they have few manufacturers. A single failure can have a big impact on the health system, experts told The Post.

Akorn had not been shipping its 20-millilter bottles of liquid albuterol for several months, according to Premier. Now the closure threatens to prolong those shortages in 2023.

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Products from the one remaining major domestic source of liquid albuterol, Nephron Pharmacuticals, have been on back order with the Akorn shutdown, Gurz said.

Nephron started shipping albuterol last Friday, but to get back on track, “it’s going to be an uphill climb,” Gurz said.

When it heard from members having difficulty finding enough supply, the Children’s Hospital Association worked with STAQ Pharma, a facility that provides compounded pediatric medication, to start production on batches of albuterol.

Meanwhile, hospital pharmacies are keeping an eye on their supplies, trying to stock extra medicines.

“When you have supply chains that are just-in-time, it can create some issues when something goes off,” T.J. Grimm, the director of retail and ambulatory services at University Hospitals in Cleveland, told CNN.

“There’s the short-term crisis we all have to get through and then there’s a longer term,” Grimm said. “We need to think about these things a little more strategically, especially with our kids.”