A new asthma inhaler that's better for environment
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By JESSICA BELASCO San Antonio Express-News - Published: August 6, 2008
Since she was 5, Jodi Davis has used a generic albuterol inhaler to help control her asthma.
Three months ago, Davis, now 13, became one of 40 million Americans with asthma and other respiratory problems making the switch from rescue inhalers containing ozone-damaging chlorofluorocarbons (CFC) to inhalers containing the more environmentally friendly hydrofluoroalkane (HFA).
The switch is a result of a Food and Drug Administration ruling making it illegal to manufacture or sell CFC inhalers after Dec. 31. The United States has been phasing out CFCs since the Montreal Protocol in 1987, but asthma inhalers had been exempt until new technology could be developed.
Davis, who uses her inhaler mostly when she plays sports, hardly noticed a difference with her new one.
"It tastes a little sweeter," said Davis, who lives near La Coste, Texas. "But it's safe for you and the environment."
Asthma patients and the medical community are finding that HFA inhalers come with both benefits and problems.
Both CFC and HFA inhalers deliver a specific, measured dose of the same medicine with each pump. The only difference is the chemicals used to propel the medicine.
Like the CFC inhalers, the HFA inhalers sold under the brand names ProAir, Ventolinand Proventil contain albuterol, a medicine that relaxes the muscles that constrict airways during asthma attacks. The aerosol inhaler XopenexHFA contains levalbuterol, a medicine similar to albuterol.
HFA inhalers may even be more effective than CFC inhalers because the particle size of the albuterol is smaller and the velocity of the puff is slower, making it easier for the medicine to penetrate the lungs, according to Dr. Mike Vaughn of Alamo Asthma & Allergy Associates in San Antonio.
But that same change in velocity and particle size alarms some users who miss the "blast in the throat" they're accustomed to with the CFC inhalers, he said.
"They're worried it's not working," said Vaughn, who has been switching patients to the HFA inhalers for about a year. "It's just going to take some time to get used to the new, gentler puff that comes out of this inhaler."
Asthma patients face other changes when using the HFA inhalers, including a different smell and taste, a different manner of priming the inhaler before use and the need to clean the mouthpiece to prevent clogging.
Kim Davis, Jodi's mother and executive director of the Asthma Coalition of Texas, said getting used to those changes is worth it.
"It's better for the environment and since asthma is connected to the environment, it's a good thing," said Davis, who also has asthma.
Vaughn says his patients have adapted easily to the switch. But Stu Walker, pharmacist at Oak Hills Pharmacy, has customers who plan to buy CFC inhalers as long as they can.
"I have patients who are afraid to change because they get such great results with the old one," he said.
In fact, in some areas, asthma patients are stockpiling all the CFC inhalers they can, said Dr. Michael B. Foggs, chief of allergy and immunology for Advocate Health Care.
That may be partly due to the increased cost of the HFA inhalers. Albuterol CFC inhalers are generic, but there is no generic version of albuterol HFA inhalers yet, so they cost at least $20 more per canister than the generic version, according to the South Texas Asthma Coalition.
CFC asthma inhalers used to cost about $13 to $14 out of pocket, although as manufacturers discontinue them, the price has risen to $18 to $20, Walker says. HFA inhalers sell for around $36 to $45 out of pocket.
Patients with health insurance may see no difference in their co-pays, while some insurance companies charge more for brand-name prescriptions than generic.
"There's a concern for people who have absolutely no health insurance at all," said Dr. Norman Edelman, chief medical officer of the American Lung Association, which supports the ban on CFCs. "We hope that within short order, there will be lots of competition among various manufacturers, and the price will come down again."
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