Akorn's closing may prolong asthma med shortages, but treatment options still available

The sudden closure last week of a Gurnee-based pharmaceutical company may prolong shortages of treatments for RSV and asthma.

Akorn, which operated manufacturing plants in Decatur, New York and New Jersey and a research facility in Vernon Hills, produced albuterol sulfate inhalation solution, used to treat asthma and other respiratory conditions. The shutdown of the Decatur facility left just one remaining domestic supplier of the medication, which the Food and Drug Administration currently lists as “in shortage.” It has been on the shortage list since last fall.

Some panic buying is likely to occur, said Paula Gurz, senior director of pharmacy contracting for Premier Inc., a health care supply chain and technology company that works with more than 4,400 U.S. hospitals and health systems and approximately 250,000 other providers.

“However, inhalers and nebulizer treatments should continue to be available,” Gurz said. “Akorn's presentation was the larger 20 mL inhalation solution, used specifically in hospitals for continuous drug delivery to manage exacerbations of asthma.”

The good news is an albuterol alternative exists, said Dr. Scott I. Song, a board-certified specialist in allergy and immunology with offices in Libertyville, McHenry and Palatine. While albuterol sulfate is in short supply, levalbuterol is available, Song said, although it is more expensive than its counterpart and may not be covered by insurance.

In every case, Song recommends people with asthma purchase a peak flow meter, an inexpensive hand-held device that measures how air flows into the lungs and is available over the counter for between $15 and $25.

“It is an absolute requirement,” Song said. “Every asthmatic should know where they stand with their numbers.”

According to Gurz, Premier's members ran out of supply around October.

“We have been hearing about albuterol shortages for several months as the market has been strained due to the tripledemic (COVID, flu, RSV),” Gurz said.

“It was a concern; however, we anticipated that the product would return to market,” Gurz said, adding that hospitals were conserving the 20mL for specific patients.

The FDA said it began drug supply reviews after the Akorn shutdown.

“The FDA is reviewing all drugs affected by this closure and is working with the other manufacturers to understand the supply nationwide,” the agency said. “If the approved manufacturers cannot meet market demand, the FDA will add those affected medicines to our Drug Shortage webpage and continue working to resolve or lessen the impact of those shortages using all the tools we have available.”

If it determines a shortage exists, the FDA has the authority to expedite approvals for new manufacturing lines, extend expiration dates and hunt for foreign suppliers.

In the last two months, the Children's Hospital Association has ramped up an alternative supply of liquid albuterol from a partner supplier, STAQ Pharma, according to the association. Because STAQ is a new producer, the expiration date on its product started at just 32 days, which will require careful planning and frequent deliveries, the association said.

The shortage has not affected the practice of Dr. Zachary Rubin, a pediatric allergist and immunologist with Oak Brook Allergists.

Rubin said the albuterol shortage during the pandemic forced local doctors to change treatment plans for patients with asthma. Like the current shortage, the shortage during the beginning of the pandemic affected the type of liquid albuterol used in nebulizer devices. Rubin said that meant they would resort to prescribing inhalers that also contained albuterol to patients instead.

Rubin said that while there is evidence to suggest an albuterol inhaler can be substituted for an albuterol nebulizer, it is harder for patients to use. A 2019 study by University of Colorado School of Medicine based on data collected from 7,558 patients found 84% of asthma patients use their inhalers incorrectly.

“With a nebulizer, it is just a mist coming through,” Rubin said. “If you have a younger child, they might not be able to use an inhaler.”

• The Washington Post contributed to this report.