The 2023 albuterol shortage, in the liquid hospitals use for nebulizers

On Oct. 25, 2022, FDA added albuterol sulfate solution to its national drug shortage list. The entry covered the liquid form of albuterol, the asthma rescue drug, that is run through a nebulizer and turned into a mist. Hospitals use it by the vial in emergency rooms and intensive care units, sometimes continuously for hours. According to FDA's own shortage records¹, the listing stayed open for 1,402 days, a long run even by the standards GxRadar measured in how long drug shortages last, before the agency's last update, on Aug. 27, 2026, marked it resolved.

Most accounts file it as a 2023 story, because that was when it got worse. In February 2023, according to a March 2023 note from the American Lung Association³, a major US maker of the solution shut down production at three factories, leaving one remaining US manufacturer facing growing demand.

This account rebuilds the timeline from FDA's shortage data, the agency's annual reports to Congress and three published hospital studies. The shortage started with a surge in demand and deepened when supply fell away, and hospitals changed how they give the drug to stretch what they had. Little of that is explained by FDA's public record on its own.

What FDA's records show

FDA's shortage database is the list the agency's Drug Shortage Staff keeps of drugs it has determined are scarce nationally. Its FAQ² says the list includes "the reason for the shortage as determined by FDA" and is updated daily. The same data are published through the openFDA drug shortages API¹, which GxRadar uses for its shortage tracker.

Today the albuterol entry is thin. The openFDA record lists three presentations, each 2.5 mg of albuterol in 0.5 mL of solution, all first posted Oct. 25, 2022, all marked "Resolved" with a note reading "Available." FDA filed the drug under two therapeutic categories, Pediatric and Pulmonary/Allergy. The reason field is blank.

Metered-dose inhalers, the kind most patients carry, were a separate matter. The Lung Association³ wrote in March 2023 that those inhalers "do not seem to be impacted by the shortage so far." The squeeze fell on the liquid, which the Lung Association noted is the format used for continuous nebulizer treatment in hospitals and emergency departments.

Sources: openFDA drug shortage records retrieved Nov. 3, 2026, and the publications linked in this article.

How FDA described the cause

FDA's annual reports to Congress do not name albuterol, but they describe the conditions it was listed in. The report for calendar year 2022⁴ says there were "dramatic and rapid changes in demand for some products used to treat infectious diseases such as COVID-19, respiratory syncytial virus (RSV), and seasonal influenza." It singles out amoxicillin oral suspension as an example, a story GxRadar covered in The amoxicillin shortage of 2022 and 2023.

FDA's 2023 report⁵ goes further. "More than half of the shortages seen in CY 2023 were due, in part, to increases in demand," FDA wrote, adding that the confluence of COVID-19, RSV and flu drove "substantial increases in demand for many respiratory products." Its example was cromolyn sodium concentrate, another inhaled drug, which is still on FDA's current list with a first-posted date of Nov. 3, 2023. The same report notes that "closures of facilities" had put further strain on supply. FDA counted 49 new shortages in 2022 and 55 in 2023.

FDA also flagged a blind spot. Under the law as FDA's FAQ² describes it, manufacturers must notify the agency of discontinuances and of manufacturing interruptions likely to disrupt supply. A jump in demand is not on that list. The 2023 report⁵ says manufacturers "are not required to notify FDA about shortages related to increases in demand, and this hampers FDA efforts to prevent or mitigate them."

Supply then fell away. The Lung Association described the February 2023 plant shutdowns and wrote that one US manufacturer remained. That pattern, few makers and little spare capacity, is the one FDA's 2019 study of shortage root causes⁷ found behind most shortages of older generics. GxRadar's explainers on why some generics have only one maker and why drug shortages happen cover that economics.

What hospitals did

Three published studies from children's hospitals show the response in numbers. They describe institutional protocols, written by clinicians for their own units, and are not guidance for patients.

Sources: Pediatric Quality & Safety, 2025⁸; Pediatric Emergency Care, 2025⁹; Pediatric Pulmonology, 2025¹⁰.

According to the Ohio team's full paper¹¹, a respiratory surge in fall 2022 brought a 66.6 percent increase in asthma visits over two months. By November 2022 there was "a critical nationwide shortage of albuterol nebulizer solution." Without changes, the authors wrote, there was concern the drug "would not be available when needed."

The Seattle study¹² adds a regional detail: national shortages had "led to rationing of albuterol in the region." Its authors, writing in 2025, also noted that the shortage had since "improved and many hospitals no longer report difficulties obtaining this medication."

In Indianapolis, the intensive care paper¹³ dates its protocol change to early 2022, months before FDA's listing. That gap is common. Hospitals feel a squeeze in their own orders before FDA concludes that national supply falls short of demand, the test its FAQ sets out. GxRadar explains how that determination works in How FDA tracks drug shortages.

Why the liquid form was exposed

Albuterol solution has the profile FDA's 2019 report⁷ describes for shortage-prone drugs. It is old, it is generic, and it sells for little. Of 163 drugs that went into shortage from 2013 to 2017, that report found, 67 percent had a generic version and their median time since first approval was almost 35 years.

FDA's FAQ² gives the mechanism in a sentence: "When one company has a problem or discontinues its production, it can be difficult for the remaining firms to increase production quickly, which can result in a shortage." With one US maker left, a plant closure could not be absorbed quickly, and demand was already high.

All three hospital studies above come from children's hospitals, and FDA filed the listing under its Pediatric category. Seventeen drugs on FDA's current list carried that tag as of Oct. 30, 2026; GxRadar's Pediatric drug shortages looks at them.

What to watch

New shortages have since fallen sharply. FDA's report for calendar year 2025⁶ counts four new shortages that year and 93 ongoing at year end. The demand blind spot the 2023 report described has not been closed in the notification rules FDA's FAQ lists today; GxRadar's piece on how FDA works to prevent shortages covers where the agency's powers stop.

For anyone told a medicine is hard to find, the practical questions are for a pharmacist or prescriber, and our guide on what to ask when your medicine is in shortage lists them. FDA's definition of a shortage is in the GxRadar glossary, and the full current list, updated from FDA data, is on our shortage tracker.