Asthma 'Rescue' Inhalers Are Changing

MONDAY Nov. 10, 2008 -- Change is coming to the lifesaving asthma medications known as "rescue" inhalers.

And, if you're one of the estimated 40 million people with a respiratory disorder who uses these inhalers, you need to know that after Dec. 31, you won't be able to buy an inhaler that uses chlorofluorocarbon (CFC) propellants anymore. Plus, you need to be aware that the new inhalers are different in some important ways: They won't feel the same when you use them, they have different cleaning requirements, and they may cost you more.

"The main reason for this change is that the new inhalers don't create an ozone loss," explained Dr. Ira Finegold, chief of the division of allergy and clinical immunology at St. Luke's-Roosevelt Hospital in New York City.

Chlorofluorocarbon propellants have been linked to destruction of the Earth's ozone layer.

Finegold was scheduled to moderate a weekend session detailing the inhaler changeover at the American College of Allergy, Asthma and Immunology's annual meeting, in Seattle.

The inhalers included in the changeover contain albuterol or levalbuterol, active ingredients that help quickly open the airways during an asthma attack. Inhalers that contain corticosteroids -- medications that prevent asthma attacks from occurring -- aren't included in the new mandate.

Until recently, inhalers delivered the medication through the use of chlorofluorocarbon propellants. But, the U.S. Food and Drug Administration mandated that starting on Jan. 1, 2009, manufacturers would only be allowed to sell inhalers that use more environmentally friendly hydrofluoroalkane (HFA) propellants, which don't damage the ozone layer.

While the medications delivered through HFA inhalers are effective, there are some significant differences between HFA and CFC inhalers that people need to be aware of. They include:

  • Priming. When you first use an inhaler, or if you haven't used it in awhile, you need to "prime" the pump to ensure that you're getting the accurate dose of medication. Priming entails spraying a dose or doses into the air, and priming requirements are different for each inhaler. Ask your pharmacist or check the package insert for your inhaler's priming requirements.
  • Inhaling. The spray from HFA inhalers doesn't come out as forcefully, and some people have reported feeling as if they're not getting enough medication. "A lot of people who say the inhalers aren't working may not be using proper inhalation technique," said Nancy Sander, president of the Allergy and Asthma Network Mothers of Asthmatics. "It's your inhalation that carries your medicine where it needs to go. So, start to breathe in as you press the inhaler." For more detailed instructions on the proper technique for using an inhaler, ask your doctor or pharmacist, or check the package insert, which also has instructions for using the inhaler.
  • Cleaning.HFA inhalers need to be cleaned more often than CFC inhalers. "HFAs are a little more sticky and tend to accumulate. If you see white powder in your inhaler, that's a dirty inhaler," said Sander. Finegold said all you need to do to clean the inhaler is rinse it in warm water and let it dry out overnight.
  • Cost. Because pharmaceutical companies had to come up with new ways to deliver old medications, there are no longer generic versions of albuterol inhalers available. That means you may pay more. Sander said she's heard that people who were paying $4 for a generic inhaler are now paying as much as $35 to $60 for their inhalers. She said that manufacturers have set up a coupon program to help offset some of the cost difference, but most people aren't aware of this program. Check with your doctor or directly with the manufacturer of your inhaler for more details.

If you still have a CFC inhaler, you can use it after Dec. 31, and you won't be breaking any laws, Finegold said, but you won't be able to buy such an inhaler after that time. And, he said, in many areas of the country, CFC inhaler supplies are already gone and pharmacies have switched to HFA inhalers.

More information

To learn more about the new HFA inhalers, visit the Asthma and Allergy Network Mothers of Asthmatics.

Posted: November 2008


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