Albuterol and Caffeine in a Crisis: How Coffee Opens Airways for Asthma

One of the earliest drugs for asthma was discovered in 1888. Theophylline is a natural plant-based compound that was originally extracted from tea leaves. The active compounds, methylxanthines, can also be found in coffee, maté and cacao beans. More than 100 years ago physicians started using theophylline to open airways in patients with asthma. Because caffeine is also a methylxanthine, it has somewhat similar properties on the cardiovascular system and the smooth muscle of the lungs. That’s why caffeine or regular coffee opens airways in a pinch.

Albuterol Is First Choice as a Rescue Inhaler:

We call albuterol a “rescue inhaler” because it is a SABA (short-acting beta agonist) bronchodilator. I would love to dig into the basic pharmacology of beta agonists, but time is short and you would get bored very quickly. Suffice it to say that the smooth muscle in your lungs often becomes constricted during an asthma attack. Because beta receptors on those smooth muscles respond to compounds like albuterol (a beta agonist), airways open and breathing improves.

Here is a recent question in this regard:

Q. I woke up a few weeks ago unable to catch my breath. It is a scary feeling, and I was freaked out. Fortunately, my wife had an albuterol inhaler handy that she uses for asthma. That seemed to solve the problem. Is there anything else I could use if this happens again?

A. Albuterol is considered a “rescue inhaler” for people with asthma. We can’t explain why you had a breathing problem upon awakening, but the inhaler opened your airways.

There are a couple of other options you could try in case this ever happens again. You can now buy an over-the-counter epinephrine (adrenaline) inhaler (Primatene Mist) that works in a similar manner to albuterol.

In addition, you might want to consider a cup of strong coffee. Here is a message from another reader who found that coffee opens airways:

“I’ve had asthma since childhood and learned by accident that drinking a cup of coffee could ease a sudden asthma attack. These are usually connected to a sudden change in the weather. The coffee relieves chest tightness and eases my breathing.

“As a nurse in a day hospital, I have noticed that patients occasionally get a flare-up of asthma post-procedure. If they were coffee drinkers, we’d give them a cup, and that worked.”

The caffeine in coffee is chemically related to a drug called theophylline. This was once a mainstay of asthma treatment because it opens airways.

We urge you to see your doctor to find out what might have caused your breathing problem.

When an Albuterol Inhaler Did Not Work:

Using expired medicine is a bad idea, especially when it comes to asthma. Fortunately, coffee opens airways and helped avert a breathing problem.

Q. I ran this morning and was having trouble breathing and felt tightness in my chest. I took 2 puffs of my expired inhaler because it was all I had. It did not help. I just drank about 10 oz. of coffee and I feel so much better. I am going to my doctor to get a new prescription of albuterol, though.

A. Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA) is the bronchodilator that most physicians prescribe to open airways during an asthma attack. It sounds like you were experiencing exercise-induced asthma. This is a good reminder to keep all medications, especially asthma medicine, up to date!

In a pinch, caffeine can often be helpful for people with asthma. Physicians have known about the beneficial effect of coffee for treating asthma since at least the 19th century (Edinburgh Medical Journal). Research has shown that caffeine can open airways and improve asthma symptoms (New England Journal of Medicine, March 22, 1984). The dose is around three cups of strong coffee for an average adult.

Caffeine is related to theophylline, an old-fashioned asthma drug. As a result, decaf coffee will not work.

A methodical review of the medical literature concluded that caffeine can:

“improve lung function for up to four hours” (Cochrane Summaries, Oct. 5, 2011).

When nothing else is available, a few cups of strong coffee might help.

More Stories Suggesting that Coffee Opens Airways in an Emergency:

Many years ago we received this thank you note from a reader of our first book:

Q. I want to thank you for helping me out of a medical emergency. I was flying across country and had packed my asthma medicine in my carry-on luggage. The flight was too full and there was not enough room for my case so the flight attendant checked it.

During the flight I began to have an asthma attack. They didn’t have my medicine in the first aid kit and I started to panic. Luckily I remembered reading in your book, The People’s Pharmacy, that coffee can help in such a situation. I drank four cups and my breathing gradually improved. I am so grateful.

A. We are delighted that the coffee remedy helped you out of a jam. Obviously, you had planned well in packing your asthma medicine to be with you on the plane. But sometimes good plans go awry.

Research proving that the caffeine in coffee opens airways was published in no less a journal than the prestigious New England Journal of Medicine (March 22, 1984).

The investigators wrote:

“We compared the bronchodilator effects and pharmacokinetics of orally administered caffeine (10 mg per kilogram of body weight) and theophylline (5 mg per kilogram) in a double-blind, single-dose study in asthmatic patients 8 to 18 years of age. After 48 hours of withdrawal of all methylxanthines, 13 patients received caffeine and 10 received theophylline. Significant improvements in forced vital capacity, forced expiratory volume in one second, and forced expiratory flow rates occurred from one to six hours after administration of either caffeine or theophylline. The bronchodilator effect of caffeine did not differ significantly from that of theophylline and was maximal two hours after ingestion of each drug…Mild, transient side effects were seen after both caffeine and theophylline. Vital signs did not change significantly after either drug. We conclude that caffeine, a commonly available chemical, is an effective bronchodilator in young patients with asthma.”

Shortly after that story ran in our syndicated newspaper column, we heard from a flight attendant that coffee opens airways in an emergency.

Q. I am an international flight attendant. I was pleased to read in your column that coffee might be used for asthma in an emergency. I think we have some kind of asthma medication in our enhanced medical kit, but just in case I now know we can use coffee as a backup plan.

A. We would hope that the emergency medical kit that most airplanes carry would have an effective rescue inhaler such as albuterol. But in an emergency situation coffee open airways. Hopefully there would be a doctor on board to supervise.

The Controversy Over Asthma Inhalers:

There was controversy surrounding HFA asthma inhalers compared to the old CFC inhalers. HFA stands for the propellant chemicals called hydrofluroalkanes. They have replaced the older CFCs (chlorofluorocarbons) which were believed to harm the ozone layer.

Many patients complained that the HFA inhalers were less effective, even though the FDA maintained that they were just as good. Experts insist that while the “feel” of the inhaler is different, the effect of the medication is identical. Here is what visitors to our website say:

Missy offers this perspective:

“When I was able to use the CFC albuterol inhalers, my asthma was well controlled. I could afford the medication on a limited income, and it lasted me for a few months.

“When I was forced to switch to the HFA inhalers, my asthma got worse. I can no longer tolerate certain smells. Too much cigarette smoke in my face sets me off. The smell of perfume leaves me gasping for air. When I take a walk, I have to walk slowly. There were times I’d lay in bed to sleep at night, and would find myself gasping for air.

“I’ve nearly passed out due to lack of air, and the HFA inhalers do not offer much relief.

“I am having difficulty breathing. My lungs feel like they are on fire, and I’m praying it doesn’t worsen. I’ve taken two puffs of the HFA albuterol, and it doesn’t seem to be helping. I know how to take the inhaler, so it’s not me. It’s the inhaler.

“I also feel that our complaints have been largely ignored by the FDA, the Congress, the government in general. I want to see the CFC inhalers put back on the market. Once they are, we asthmatics will not need to live in fear of suffocating to death.”

Courtney also complains about the “new” inhalers:

“The new inhalers are not effective. They do not work! They do not last for the 200 doses they are supposed to; you are lucky IF they last for 50. And unlike the old inhalers most of the puffs you do get are wasted priming the stupid things. So you actually can use only a small part of the 50 working puffs. The propellant seems to leak out of them after you use them. These inhalers don’t bring relief either. I have had to revert to using my nebulizer which is not convenient and severely limits my activities in comparison to having access to 1 puff of the old style albuterol inhaler!

“I have had several attacks recently get very serious and have almost gone to the E.R. for asthma treatment for the first time in YEARS because I got no or very limited relief from the inhaler.

“I would like to have access to an inhaler that actually works. As it stands, I am paying 5x as much for something that doesn’t work or provides very limited relief and in attempting to use this product I’m having to get refills 6x as often. I am paying a LOT more to feel a LOT worse!”

Final Words About Asthma and Coffee Opens Airways:

There are many more asthma drugs available these days. Quite a few contain a long-acting bronchodilator (LABA) and a corticosteroid. They work very well for most patients.

We have become quite concerned about fluoride compounds in pharmaceuticals, though. Dr. Linda Birnbaum alerted us to the fact that many inhaled anesthetics contain fluoride. That’s something we never thought about until we interviewed her. She was the director of the National Institute of Environmental Health Sciences and the National Toxicology Program. Perhaps you have heard of PFAS (per- and polyfluoroalkyl substances) in our environment. You can learn more about these forever chemicals by listening to our podcast with Dr. Linda Birnbaum. Here is a link:

Show 1404: How You Can Avoid the Harms from Forever Chemicals

More recently we interviewed Dr. Bruce Lamphear about his concerns regarding fluoride in water and pharmaceuticals. Here is a link to that show.

Show 1418: More About the Pros and Cons of Water Fluoridation (Part 2)

What pharmaceutical manufacturers don’t like to talk about are fluoride compounds in medications. Most metered dose inhalers rely upon fluorinated hydrocarbon propellants (HFCs) or HFA (hydrofluoroalkane). We wish the FDA would require more long-term testing of the effects of such propellants. They may be absolutely safe, but concerns about PFAS in the environment are relatively new. As a result, we are not sure the FDA has even considered the safety of medications containing fluorinated compounds.

We hope that your asthma is well controlled and that you have excellent medical supervision to make sure your medications are working as expected. Never let your medicines expire so they won’t let you down in an emergency. Do remember, though, that if you get separated from your rescue inhaler, coffee opens airways. It won’t work as well as prescribed asthma medicine, but it may help in a pinch, such as when you are in an airplane at 30,000 feet.