FRIDAY, May 30 (HealthDay News) -- Asthma inhalers that contain
the drug albuterol to relax the airways also contain chemicals that
harm the ozone layer. And these inhalers won't be available after
this year, so U.S. health officials are urging patients to switch
to alternative inhalers now.
Chlorofluorocarbons, or CFCs, are widely used to propel inhaled
drugs into the lungs. However, products containing CFCs are being
phased out, because the chemicals damage the Earth's protective
ozone layer. CFC inhalers are being replaced by inhalers powered by
HFAs, or hydrofluoroalkanes, which are ozone-friendly.
The change to HFA-powered inhalers has been in the works for
several years, but the FDA issued an advisory on Friday, urging
patients still using CFC inhalers to switch now. Inhalers
containing CFCs will not be available after Dec. 31.
FDA officials said people with respiratory problems, such as
asthma and chronic obstructive pulmonary disease, may need some
time to acclimate to HFA-based inhalers.
"There are 52 million prescriptions written for albuterol
inhalers each year in the United States," Dr. Badrul Chowdhury,
director of the U.S. Food and Drug Administration's Division of
Pulmonary and Allergy Products, said during a teleconference.
Albuterol is used to treat shortness of breath in people with
asthma and chronic obstructive pulmonary disease, he noted.
Chowdhury said that approximately 65 percent of inhaler users
have already switched to HFA inhalers.
"These new handlers may taste and feel different than the
current CFC inhalers," he said. "In addition, HFA inhalers may feel
softer than CFC inhalers."
Also, patients using HFA inhalers will have to prime and clean
them to prevent the buildup of albuterol in the inhalers' nozzle.
This buildup could block the medicine from reaching the lungs,
Chowdhury said.
Each HFA inhaler has a different priming mechanism and cleaning
and drying instructions. So, users should carefully read the
instructions before using the inhaler. And HFA inhalers may cost
more, because there's no generic HFA inhaler available yet,
Chowdhury said.
Three HFA-propelled albuterol inhalers have been approved by the
FDA: Proair HFA Inhalation Aerosol; Proventil HFA Inhalation
Aerosol; and Ventolin HFA Inhalation Aerosol. Also, an
HFA-propelled inhaler containing levalbuterol, a medicine similar
to albuterol, is available as Xopenex HFA Inhalation Aerosol, the
agency said.
Dr. Ira Finegold, chief of the Division of Allergy and Clinical
Immunology at St. Luke's-Roosevelt Hospital Center in New York
City, doesn't see much difference in the effectiveness of the two
types of inhalers. "The end result -- if you need it, does it open
up your lungs? Yes, it does," he said.
However, the changeover will involve some patient education, he
said. "The old medication, CFC albuterol, was really a very nice
product, because the propellant got in your body and came out of
your body -- it wasn't absorbed. And remarkably, it is a cleaning
agent, so the device was self-cleaning."
The new HFA propellant is safe in the body but can clog the
inhaler, Feingold said. "So, after use, these inhalers need to be
rinsed out or they are not going to work correctly," he said.
"In addition," Feingold added, "each of the four new inhalers on
the market is different in the number of times you have to prime
it. There is also a little difference in feel and taste."
The discontinuation of CFC-propelled inhalers is the result of
the U.S. Clean Air Act and an international treaty known as the
Montreal Protocol on Substances That Deplete the Ozone Layer.
Under provisions of this treaty, the United States agreed to
stop the production and importation of substances that damage the
ozone layer, including CFCs, according to the FDA.
More information
For more on inhalers, visit the
U.S. Food and Drug Administration.