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Julianna Celestin is an ambitious-driven graduate from Florida State University, where she has obtained degrees in Family & Child Sciences and Public Health with a Minor in Child Development. She is currently pursuing a Master of Health Services Administration in Healthcare and later a Juris Master with a specific concentration in Healthcare. Her aspiration is to become a Healthcare Administrator and Researcher focused on strengthening systems solutions to public health, comprehensive health systems, and health care problems. Julianna's focus is improving access to healthcare. She is passionately committed to progressively improving the social efficiency and quality of healthcare services that are being provided and not provided to those in the underserved, underrepresented, and vulnerable populations.

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What is Endometriosis?

A woman’s uterus is lined with endometrial tissue. This lining is called the endometrium. Your body grows a new endometrium with each menstrual cycle to prepare for a fertilized egg. Endometriosis is a condition in which endometrial tissue grows outside the uterus.

According to the Cleveland Clinic, a few places one can develop endometriosis include:

  • Outside and back of your uterus

  • Fallipian tubes

  • Ovaries

  • Vagina

  • Peritoneum (the lining of your abdomen and pelvis)

  • Bladder and ureters

  • Intestines

  • Rectum

  • Diaphragm

However, where the endometriosis is developed is dependent on the stages of endometriosis per the ASRM guidelines.

What are the early signs of Endometriosis?

The most common signs of endometriosis are pain and infertility. According to the Current Obstetrics and Gynecology Reports, endometriosis pain can present as:

  • Painful menstrual cramps that may go into the abdomen (stomach) or lower back

  • Diarrhea or constipation during a menstrual period.

  • Fatigue or low energy

  • Heavy or irregular periods

  • Bloating

  • Pain with urination or bowel movement during a menstrual period

  • Spotting or bleeding between menstrual periods 

Each person’s experience with endometriosis is different. There’s no connection between the symptoms of endometriosis and the severity of the condition. Some people may have very few patches of endometriosis and still experience severe pain. Other people might have severe endometriosis, but not experience a great deal of pain.

What causes Endometriosis?

Endometriosis isn’t a condition you can necessarily prevent. Endometriosis is an idiopathic condition, meaning there is no known cause. Doctors and researchers do not know exactly what causes endometriosis, but there are a few theories of what might cause the condition.

One possible mechanism is retrograde menstruation, a feature of the menstrual cycle in women and non-human primates, which is an outflow of the endometrial lining through the patent fallopian tubes into the pelvic space.(Giudice & Kao, 2004) This retrograde flow, along with potential hematogenous or lymphatic circulation, may result in the seeding of endometrial tissue in ectopic sites Other factors, such as hormonal, inflammatory, or immunologic milieu may determine whether lesions deposited in the pelvic cavity implant persist. 

Who is at Risk for Endometriosis?

Research shows that there are some things that put a person at higher risk of developing endometriosis:

  • Family history of endometriosis

  • An abnormal uterus

  • Early menstruation

  • Shorter menstrual periods

  • Heavy menstrual periods lasting more than seven days 

Why is Endometriosis often undiagnosed in women?

Women’s reproductive health attracts far less research funding than almost all other medical research. As for endometriosis, a condition that affects between 10 and 15 percent of women of reproductive age (Giudice & Kao, 2004); the lack of research is particularly striking. It can take anywhere between 4 and 11 years for women to receive the correct diagnosis, and as many as six out of every 10 cases of endometriosis may remain undiagnosed (Agarwal et al., 2019). The lack of noninvasive diagnostic tests is one of the reasons behind this lengthy gap. 

Most women do not feel their symptoms are taken seriously. Two-thirds of women sought medical help for their symptoms before the age of 30 (one-fifth below the age of 19). Medical professionals find it difficult to differentiate between “normal” menstrual complaints and signs or symptoms suggestive of endometriosis. A U.S. study conducted in 2020 recorded that 75.2 percent of patients reported being misdiagnosed with another physical health (95.1 %), a mental health problem (49.5%), or both before they received an endometriosis diagnosis (Bontempo & Mikesell, 2020). This study further emphasized that a misdiagnosis with a mental health problem was more common in those with younger age of endometriosis symptoms (Bontempo & Mikesell, 2020).

How is Endometriosis treated?

There is no cure for endometriosis, but treatments are available for the symptoms and problems it causes. Patients should work with their healthcare provider to create a treatment plan based on their symptoms. In many cases, a treatment plan will focus primarily on managing pain and improving fertility issues (if one is planning on a future pregnancy). This can be done through medications and surgery. Medications are often used to help control the symptoms of endometriosis. These can include pain medications and hormone therapies.

The Albuterol Shortage Crisis

As per the Asthma and Allergy Foundation of America, there are roughly 25 million individuals in the United States who suffer from asthma (Goff, 2022). The Journal of Pharmacy reports that Albuterol is one of the most frequently prescribed medications in the country (Fuentes, Pineda & Venkata, 2018).

Towards the end of October 2022, the FDA announced a shortage of albuterol sulfate inhalation solution. As per the official website of the administration , the shortage still persists in early April (U.S. Food & Drug Administration, 2022). Albuterol is available in different forms, but it is the aerosolized solution that is administered through a nebulizer in hospitals that has been included in the drug shortage listed by the U.S. Food and Drug Administration. This inadequacy is especially problematic for hospital settings, where this form of the drug is predominantly utilized, but it can also be a concern for individuals who utilize it at home.

What is Albuterol Inhalation? And how is it utilized?

Albuterol is utilized to prevent and treat difficulty breathing, wheezing, shortness of breath, coughing, and chest tightness caused by lung diseases such as asthma, bronchitis and chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways) Albuterol is in a class of medications called bronchodilators (Johnson, Bounds & Merrell, 2019). It works by relaxing and opening air passages to the lungs to make breathing easier. Without the bronchodilatory effects of albuterol, the individual may suffer catastrophic asphyxiation, making this drug highly desirable to keep on hand for individuals who suffer from recurring obstructive airway symptoms such as asthma (Gardiner & Wilkinson, 2019).

The Reason Behind the Shortage

Akorn Operating Company LLC was recognized for its specialization in manufacturing and marketing of pharmaceuticals. Their product line included prescription drugs, consumer health items, and animal health products. They were distinguished for their expertise in producing both branded and generic medications in various alternative forms such as ophthalmics, injectables, oral liquids, otics, topicals, inhalants, and nasal sprays. However, in May 2020, the company filed for Chapter 11 bankruptcy (Becker, 2023).

Akorn was the sole manufacturer of specific albuterol products required for continuous nebulizer therapy. The absence of this particular product variant has caused hospitals to face difficulties in finding suitable alternatives. At present, some retail drug stores and healthcare systems are experiencing shortages of albuterol.

How dangerous is the shortage?

The scarcity is solely of the liquid form, which is utilized in nebulizers. Albuterol inhalers are not presently in short supply and may not ever be according to multiple sources. Nevertheless, liquid albuterol is a necessary component in healthcare facilities throughout the country, particularly in children's hospitals. As I mentioned in the November edition, in relation to the surge of Respiratory Syncytial Virus (RSV), many hospitals were packed with young children and elderly individuals who were sick with this virus earlier this winter. This resulted in a significant demand for albuterol. With the approach of spring allergy season, when millions of adults and children will experience asthma symptoms (Hornick & Bassett, 2023), the remaining limited supply of albuterol may potentially be stretched.

Is there an alternative to Albuterol?

There is a safe alternative to albuterol sulfate, which is levalbuterol. It’s just as effective in treating moderate asthma, with no difference in side effects, according to the Journal of American Family Physician (Dachs, Darby-Stewart  & Graber, 2008). Currently, there is not a shortage of it. However, a shortage could occur if demand increases.

Guidance for Patients with Lung Diseases

Prevent triggers. The US has one remaining primary source of liquid albuterol. The company is called Nephron Pharmaceuticals, and it just recently started shipping albuterol. n the meantime, it’s recommended that parents and patients with breathing problems take precautions.


According to the Centers for Disease Control and Prevention it is also important to know and avoid asthma triggers. Each individual's trigger may be different, but common triggers include seasonal allergies, carpets, pets, mold and tobacco smoke (Centers for Disease Control and Prevention, 2021). Per the American Lung Association, when using an inhaler, proper technique is very important. Individuals should make sure they are always using a spacer with an inhaler.If frequently using albuterol, talk to your doctor about daily medications that help control asthma symptoms in addition to albuterol (The American Lung Association, 2022).

Talk to your Healthcare Providers.

If you are concerned you might be impacted by the albuterol shortage, contact someone in your healthcare team. Now, if you find that one pharmacy is out of liquid albuterol, please reach out to other pharmacies. You can also talk with your doctor about medication alternatives.

May 2023 page 5

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