Epinephrine isn’t a first-choice treatment for asthma. But, in an emergency, an EpiPen can help open the airways while you wait for emergency services.

Anaphylactic reactions and asthma are different medical conditions but can cause overlapping symptoms, such as shortness of breath, tightness of the chest, and wheezing. If you have asthma, you may be wondering if it’s safe to use epinephrine — which is approved as a first-line treatment for anaphylaxis — to treat asthma symptoms.

Inhalers, such as albuterol, are often the first treatment approach doctors recommend for an asthma attack. But epinephrine, which you can inhale or take as an injection, may help in emergencies to relieve symptoms of asthma such as chest tightness and shortness of breath.

This article will take a deep dive into epinephrine and how it can be used to treat asthma, whether it’s recommended for treating asthma, the risks of using it for asthma, and how to create an asthma action plan.

Also known as adrenaline, epinephrine is both a hormone and a neurotransmitter, which means it’s connected to both your nervous and endocrine systems. Adrenaline is produced by your adrenal glands. It’s typically released when your body is under stress. It turns on your body’s “fight-or-flight,” which prepares your body to act quickly by helping you take in more oxygen.

Doctors prescribe the synthetic form of adrenaline, epinephrine, to people who experience medical emergencies such as anaphylaxis. It may also be used for heart-related conditions.

Epinephrine works in your body in several different ways, including the following:

  • It dilates your airways, making you breathe deeper and faster. This can help reduce swelling of the airways.
  • It increases blood flow to your muscles.
  • It causes your heart to pump faster.
  • It tightens your blood vessels and diverts blood to major organs and muscles that may need more blood during an emergency.

Epinephrine isn’t typically the first-choice treatment for asthma. But some people can use it in severe or life threatening situations.

Inhalation is one of the most common ways you can use epinephrine during an asthma attack. Epinephrine inhalers come in a liquid (aerosol) or nebulized form that you can inhale through your mouth.

To use an epinephrine inhaler:

  • Shake it and remove the cap covering its mouthpiece.
  • Place the inhaler into your mouth and press down while taking a deep breath.
  • Hold your breath for a little while (only as long as you’re comfortable). This helps the drug to be absorbed faster.
  • Use the inhaler only the number of times your doctor recommends.

A 2022 report notes that international asthma guidelines don’t support the use of epinephrine in acute asthma, but it may be recommended for:

  • a person with asthma that’s associated with anaphylaxis or swelling of the throat
  • a person experiencing life threatening asthma symptoms who’s far away from a doctor’s office or hospital
  • a person with asthma who’s unresponsive to standard treatment

According to a report from 2004, using epinephrine for asthma comes with some risks:

  • Some people with life threatening asthma may not respond to inhaled epinephrine, and this may lead to respiratory failure.
  • Not everyone will understand how to use epinephrine correctly for asthma.
  • It may cause side effects such as dizziness, shakiness, and, rarely, heart issues.
  • If a doctor administers epinephrine using a tube inserted into your trachea, you may experience changes in your vital signs, including your respiration and pulse rate.

You can use an EpiPen if you experience severe asthma symptoms and you don’t have your inhaler or access to a doctor’s office or hospital. But if you have shortness of breath, call 911 immediately to get emergency medical services.

According to the Asthma and Allergy Foundation of America (AAFA), the use of EpiPens for treating asthma isn’t popular today because several other medications provide quick relief from asthma symptoms. But, in the past, injectable epinephrine was used in emergency rooms to treat asthma symptoms that weren’t responding to standard treatment.

People with a history of asthma and anaphylaxis can use an EpiPen before taking asthma medication. This is because anaphylaxis and asthma have some overlapping symptoms, and it may be difficult to tell if what you’re experiencing is an anaphylactic reaction, asthma symptoms, or both.

Asthma and anaphylaxis do co-occur. A 2020 study observed that a history of asthma is linked to severe anaphylaxis in children.

But there are differences between the conditions.

Caused by the immune system reacting to an allergen.Caused by factors such as sensitivity to allergens, genetics, and environmental factors.
Typically affects the whole body.Primarily affects the lungs and airways.
Typically causes hives to appear on the body.Doesn’t cause hives to appear.
Typically starts immediately after exposure to allergens, such as a bee sting, food, or medication.Asthma symptoms can come and go or worsen over time.

What to do in an asthma emergency

In an asthma emergency, call 911 or local emergency services and use your rescue inhaler.

Albuterol belongs to a class of medications called bronchodilators. It’s approved for treating asthma and is often the first choice for asthma attacks. It helps open and relax the airways to increase the flow of air into the lungs, making breathing easier.

Although epinephrine is considered safe for occasional use in people with asthma, experts believe albuterol works better. A 2019 study indicated that albuterol may be more effective for treating both mild and severe asthma symptoms, when compared with epinephrine.

Other medications used to treat asthma

Other medications doctors may prescribe for asthma include:

  • quick-relief medications such as albuterol, oral corticosteroids, and ipratropium
  • medications for asthma triggered by an allergen, such as immunotherapy medications
  • long-term medications for managing asthma, including combination inhalers, leukotriene modifiers, and theophylline
  • medications for stopping underlying biological reactions that trigger lung inflammation, such as omalizumab, mepolizumab, and benralizumab

An asthma action plan is an actionable, step-by-step, personalized plan that shows what you and your healthcare team can do to help manage your asthma, prevent asthma attacks, and prevent the condition from getting worse.

Here are some tips for creating an individualized asthma action plan:

  • Include a section for recognizing when your symptoms are worsening.
  • Include details on medications you should take and when to take them.
  • The plan should outline what you should do in an emergency situation.
  • It should highlight when you should call a doctor or dial 911 or local emergency services.
  • Health organizations like the Centers for Disease Control and Prevention (CDC) and AAFA have downloadable templates that you may find useful for creating your own asthma action plan.

Epinephrine works by tightening blood vessels and relaxing the muscles in the airways. Doctors often prescribe it for treating severe allergic reactions in people experiencing anaphylaxis. But you may also use it if you have asthma, as it can provide some relief for asthma symptoms such as trouble breathing and narrowing of the airways.