In November 2018, the FDA approved Primatene Mist for the treatment of mild intermittent asthma. As it is the only over-the-counter inhaler approved by the FDA, some individuals with COPD may consider using it. The active ingredient is epinephrine which plays an important role in the fight-or-flight response; it stimulates the heart to beat faster and harder. Misuse and overuse of Primatene have been well documented and has been associated with people dying. Also, patients may self-medicate with Primatene Mist, thereby delaying effective care. I advise against use of Primatene Mist because of safety concerns. Albuterol is a safer alternative, but requires a prescription.