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Patients Balk at New Asthma Inhalers

HFA inhalers are better for the environment but how about the patients?

By Henry J. Fishman, M.D.
ConsumerAffairs.com

December 7, 2007

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Over the last year or so, millions of asthmatics have been forced to change their emergency medicines, called bronchodilators or airway openers.

Patients have been turning in the old fashioned ones, which contain a medicine called albuterol and a propellant called CFC (chlorofluorocarbon) for new ones which contain a propellant called HFA (hydroflouroalkane). While the new ones work as well or better than the old ones, they are usually more expensive, do not taste as good, and can be hard to come by.

But some patients, like Cheri of Milwaukee, claim the new inhalers aren't as effective.

"I cannot tolerate the ProAir HFA and it actually made my asthma worse. I fear that others who have been switched to HFA propelled inhalers are having increased asthma symptoms, and may not even realize why," she said in a complaint to ConsumerAffairs.com.

Cheri and other asthma patients have been circulating an online petition protesting the switch to the new inhalers.

Why the change?

So, why the changes and why all the fuss?

CFC’s have been used as the propellant for asthma medicines since the 1950’s. Most of you have seen an asthma inhaler. You put it in your mouth, hit the top, and medicine blows into your mouth. CFC’s mix with asthma medicine so it blows out easily. CFC’s are chemically stable, remain a liquid at high pressure, are non-flammable, have low toxicity and evaporate quickly when they hit the air.

For years CFC's were a great propellant and patients and doctors were happy.

Then in the mid 1970’s researchers found that CFC’s hurt the atmosphere and, indirectly, us. After a person breathes in a CFC, it is exhaled into the atmosphere. The CFC is inert, rises up, and ends up in the stratosphere, where it can remain for a hundred years or more.

Light interacts with the CFC’s to produce Chlorine gas, which attacks the ozone layer. Harmful ultraviolet rays enter the earth through holes in the ozone and cause damage to crops, animals, and people. UV light can lead to skin cancer, melanomas, sunburn and eye damage.

In 1987, a conference held in Canada issued the Montreal Protocol, which called for a 50% reduction in ozone-depleting substances by 1998 and their elimination by 2000. The use of CFC’s in asthma inhalers was allowed for a few years under the Essential Use Act. This exemption was not permanent and ran out this year.

The extension allowed scientists the time to find a new propellant -- the HFA’s. It also gave the pharmaceutical companies time to develop HFA containing products and bring them to market.

In 2007, the exemption ran out. All meter dose inhalers must now contain HFA, which is a pretty good propellant. It is better for the atmosphere than CFC and makes for a smaller particle. Smaller particles get in the lungs better, so HFA inhalers work as well or better than the old-fashioned ones.

Problem is, not everyone likes the new medicines. They contain a small amount of ethanol, which can irritate the lungs, and they have a different taste and smell than CFC inhalers. HFA can stick to the insides of the inhaler or the valve, so a full dose may not come out. Finally they can be a bit more expensive and harder to find than CFC inhalers because of supply issues.

HFA inhalers are now mandated by law and they have less impact on the ozone layer than CFC inhalers. The only constant in life is change. So, the only real option for patients is to get used to them.

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