The recent FDA decision to put Primatene Mist back on drugstore shelves was met with alarm by asthma specialists and respiratory health groups who warned that the move will place asthma patients at risk.

Pulled from the market in 2011 along with other asthma inhalers due to environmental concerns about their ozone-depleting chlorofluorocarbon (CFC) propellants, a CFC-free version of the drug was approved last November for over-the-counter (OTC) sale — despite objections from the American Thoracic Society (ATS), American Lung Association and other health groups that the move could led to suboptimal treatment and poorer asthma control if patients rely solely on the OTC medication to treat symptoms.

And now three asthma specialists, writing in the Annals of the American Thoracic Society, decry a lack of transparency leading up to the FDA’s decision.