Dr. Jeremy F. Shapiro
Pediatrician
Dr Shapiro completed his undergraduate education at UC San Diego earning a B S in Biochemistry and Cell Biology and a B A in Political Science He furthered his education at UCLA where he earned a Masters Degree in Public…
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LOCATION: Los Angeles, CA, USA
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Inhalers Go Green
15
Posted in Asthma by Dr. Jeremy F. Shapiro on Sep 30, 2008

Not really new news but since I've been approached by patients as well as fellow Daily Strength members about the inhalers we use for asthma and/or intermittent wheezing control, I felt it would be meaningful to clarify a few things about the guidelines being implemented by the U.S Food and Drug Administration (FDA).   Specifically, by the end of 2008, inhalers which use chlorofluorocarbons (CFCs) as part of the propellant mechanism to expel albuterol from the inhaler will be phased out and replaced by hydrofluoroalkane (HFA) inhalers.  And whether or not you have made the change, I'm sure many of you have the same questions:


Why the change?  CFCs are harmful to the environment by negatively impacting the ozone layer, which protects us from harmful sun rays.  Without the ozone, there exists an increased risk of developing skin cancer, cataracts and a variety of other health problems.  HFA inhalers, on the other hand, have been designed not to harm the ozone layer.


What are some of the similarities of the inhalers?  Really, they look and appear the same and they both are approved by the FDA for the same uses.


How might they differ? From what I have heard from those have used the new inhalers, the smell and taste may be different and some users are concerned they are not receiving the same benefits as when they used the CFC inhalers (but according to the FDA, HFA inhalers have undergone numerous testing to ensure their effectiveness and, in fact, the particle size released from the HFA inhalers is actually smaller than what is released from the CFC inhaler...which should mean better absorption).  Furthermore, cleaning the HFA inhaler appears to be a bit different and I recommend all users of the medication read the directions all the way through on how to appropriately care for it. 


Where can I go for further information?  The FDA has a wonderful website to address many issues surrounding the new guidelines... http://www.fda.gov/cder/mdi/albuterol.htm .   And without promoting a particular HFA inhaler, please feel free to check out the individual websites for the three albuterol HFA inhalers: ProAir, Poventil, Ventolin as well as the site for Xopenox HFA.


And for those who are now facing (or will face) increasing inhaler costs (secondary to the fact there are no generics at the present time), please check with your physician and/or the individual HFA inhaler company for discounts, coupons, and other cost-reducing options.


And for those who have used these new inhalers, please feel free to let us know your experiences.


 


Dr. Jeremy


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Displaying comments 15-1 of 15
15
My experience has been very negative-3 ekgs, cat scan, echo, creams for rashes- I experienced chest pain, increased bronco spasm, nausea and a rash which looked more like a chemical burn!!!!!! Both Pro air and Proventil HFA use ethanol which causes bronco spasm in some patients and if you have a corn allergy you'll have an adverse effect, if you are one of the people sensitive to ethanol you will have an adverse affect!! If you have adverse effects file a Medwatch complaint with the FDA, file one on consumer reports! Oh and I had to rescue my child from school for EIA because her Rescue inhaler did not relieve bronco spasms-so I have nothing good to say about the FDA taking an effective CFC inhaler and replacing a tried and true medication for the last 40 years or so with an inferior product which has not been tested as it should have been-the trail groups were small, the patients had mild asthma and some were not tested on COPD patients!!!!!Is it about the $$ and greed that consumes-profits tripled at the expense of the patient. What is wrong with the FDA and why are they not listening?
By LynnFD  Feb 25, 2009
14
Very helpful. Thank you for contributing this information.
By Ohana  Nov 08, 2008
13
I've been using the new HFA inhaler for several months now and it seems that I get better and faster relief than with the CFC inhaler. I also prefer the taste - it is more mild and the exhaled "flavor" isn't as bad.
By TwitchyLungs  Oct 16, 2008
12
I'm doing a lot of reading across the internet, and it seems like the vast majority of complaints are with ProAir inhalers. My first HFA inhaler was Ventolin HFA, and it worked about as well as I could expect from my previous generic albuterol from IVAX or Warrick. My second doctor gave me ProAir... and it seriously irritated my lungs, making me cough like crazy. My throat and lungs felt worse for hours after using it. After a couple of weeks I couldn't take it anymore and got a prescription for Proventil HFA, was was much better.

Again, it seems like there are SO many complaints about ProAir that I wonder what's going on. My pharmacist and my doctor all say that there's no difference. My insurance only covers ProAir... so I have to get an exemption to say that another brand is medically necessary. I know some patients forget to prime their inhalers or they might not be used to the spray, but c'mon -- we can't all be doing something wrong. Shouldn't someone look into why there are so many complaints about ProAir specifically, and not as many for the others?
By maddjake  Oct 12, 2008
11
this is a sideways question about spiriva inhalers. i have read that they have been linked to a much higher risk of the user having a cardiac event or a heart attack while using the drug. my husband, 63, has copd, plus asthma, and complications from post polio syndrome, ( to name a few). should we be concerned about adding to health concerns using a medication that may actually harm him?
thank you for the above article. as the mother and grandmother and wife of many asthmatics, plus being one myself, it is very helpful.
pammac92
By grampam  Oct 02, 2008
10
I have found that the new inhaler isn't as effective as the old one, however I understand why it's important to go green. A good thing came out of this switch though. I've been forced to use that peak flow meter, which I should have been doing all along. So I'm having less emergencies than I used to. It's just that when I do have a real problem, I definitely have to max out on the dose. But better control is probably better for me anyway. Thanks for writing this article -- very informative.
By KatFieler  Oct 02, 2008
9
Thank you for writing this article. I was wondering what was with the ineffective ProAir they traded out for my Albuterol!! It's nice to see other people's responses to this as well. I will go check out the site that you have listed for us. Thank you!
By htag  Oct 02, 2008
8
The only clinical study I could locate on short notice is listed in the Ventolin package insert: http://us.gsk.com/products/assets/...

The other 2 albuterol/levabuterol HFA manufacturers cite studies comparing their product to other HFA inhalers or placebo inhalers, so no help there.
By blsofsteel  Oct 02, 2008
7
As a pharmacist, I see the highest customer satisfaction with the Ventolin and Xopenex brand inhalers. The Proair is the least popular. I know its puff comes out "soft", but should deliver just as much medicine as the older inhalers.
Check with your insurance plan to see which one is preferred. One of the manufacturers was giving me $20 checks to help defray the copay cost for their inhaler.

Another option is a powder-based inhaler like Foradil.
By blsofsteel  Oct 02, 2008
6
Dr. Jeremy, Could you please point me to the clinical studies the FDA did with these inhalers? i've been using the HFA for a year now and my asthma is not the same. I was down to using my albuteral and long acting inhalers 1-2 times a week. I'm back to using my albuterol 2-3 times a DAY adn my long acting inhalers twice daily. And this was during low pollen counts and my 'off' season. Obviously it is worse during my bad season. So I'd like to know where the clinical research is because I've asked doctors and hopsitals to aide in my search and have found nothing.

Thank you!
By Purdylady  Oct 02, 2008
5
I've tried the new inhalers, which seem to have a strong alcohol component or taste. It seems to work as well as my old ones, but delivers the drug with much less force...no big puff. The price was 4x the normal price, but appears to be heading downward as everyone gets switched over.
Are there any other alternative inhalers other than the HFA units? The one I had reminded me of the Primatine mist OTC inhalers.
By jimster  Oct 02, 2008
4
I like this post. It is interesting and well written. I will definitely come back to your blog again.
By MichaelCarter  Oct 01, 2008
3
I really enjoyed reading your blog . I’m a writer myself and I like your style of writing.
By MichaelCarter  Oct 01, 2008
2
my kid has asthma,she is switching this week to these.
By SunflowerRose  Sep 30, 2008
1
My daughter does have the new inhalers. She claims they don't work at all. She said when she does take them, it burns her chest. Since I've been on an inhaler before, I decided just to check it out. It does taste a little more bitter, it did sting a little (probably because I didn't need it) and it gave me all the same reactions the old inhaler would have. She has the ProAir one.
By kazinmich  Sep 30, 2008
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