For at least the past month, Primatene Mist, the remedy of last resort for asthmatic New Yorkers–particularly for those without health insurance–has been all but impossible to obtain in the five boroughs. While some people fear they’ll be in trouble without over-the-counter inhalers like Primatene Mist should they suffer a sudden attack, many doctors are hoping this shortage will push asthmatics to seek better, prescription medication.

This spring, Wyeth Pharmaceuticals cut back its production of Primatene Mist due to manufacturing problems. At the same time, Alpharma, the company that makes most of the store brand versions of the drug, recalled over 4 million of its inhalers after failing to adequately test them–leading its customers to make a run on Primatene.

“It’s almost like a perfect storm, where these two unrelated things came together,” said Wyeth spokesperson Fran Sullivan. “What’s happening is that people are walking into stores, and absolutely coincidentally, finding nothing—there’s no Primatene, there’s no private label, in a lot of cases there’s just empty shelf.” Sullivan said the company doesn’t anticipate catching up with back orders until the first quarter of next year.

In the meantime, pharmacists across the city have been turning customers away, while urging them to see a doctor. In New York City, where over 200 people die from asthma attacks each year, and children are three times more likely to be hospitalized for asthma than kids elsewhere in the country, most pharmacists and physicians are ambivalent about Primatene Mist. While epinephrine, Primatene’s active ingredient, temporarily opens tightened bronchial passages, doctors have found that its efficacy declines with repeated use.

“Used correctly, it’s a good product,” said Bill Scheer, president of the New York City Pharmacists Society. But, he added, most of his customers, especially those without health insurance, improperly use it as their primary treatment for asthma. “That’s the problem,” said Scheer. “You get the people who are going to buy the over-the-counter, not see a doctor. When they have a shortness of breath, they’re going to use it, and if they have it again in five minutes they’re going to use it–and they’re going to keep using it until they cause a cardiac problem.”

Still, physicians recognize that without Primatene, people who can’t contact their doctors–or who don’t have doctors at all–now can’t get inhalers without a prescription. While there are other non-prescription treatments, including the pill form of Primatene and home remedies like drinking coffee, they don’t work as quickly as an inhaler.

“There are a lot of asthmatic people who have an asthma attack and won’t have anything to treat themselves with,” said Dr. David Rosenstreich, director of the Division of Allergy and Immunology at Albert Einstein College of Medicine and Montefiore Medical Center. “Someone just walks into a pharmacy, say they’re having an asthma attack, what inhaler can they get—nothing, right?”