Asthma inhalers set to go green Dec. 31

Last warning — Asthma inhalers go environmentally correct Dec. 31, thus forcing patients using the old-fashioned kind to make a pricey and even confusing switch.

The medicine inside these rescue inhalers — the albuterol that quickly opens airways during an asthma attack — isn’t changing. But the chemicals used to puff that drug into your lungs are.

No more chlorofluorocarbons, or CFCs, that damage the Earth’s protective ozone layer. By year’s end, all albuterol inhalers must be powered by the more ecofriendly chemical HFA, or hydrofluoroalkane.

The downside: The new inhalers cost more, $30 to $60 compared with as little as $5 or $10 for the disappearing generic CFC inhalers.

And patients face a learning curve. HFA inhalers must be used differently than the old-fashioned kind. The medicine feels and tastes different, sometimes alarming new users despite doctors’ assurances that it works just as well.

“There’s still significant confusion,” said Dr. Harvey Leo of the University of Michigan’s C.S. Mott Children’s Hospital. “Patients will tell you, ‘I don’t feel the puff anymore.’ ”

Calls from parents unsure how to use the new inhalers, or even what they are, have increased in the past two months as more drugstores run out of CFC-powered inhalers and automatically switch people who had been expecting a mere refill.

The change shouldn’t be a surprise. The Food and Drug Administration has long warned it was coming, and lung specialists have spent the past year easing many of the nation’s 20 million asthma patients, as well as millions of emphysema sufferers who also use albuterol to ease breathing, into it.

But industry figures show that in mid-November, 20 percent of all albuterol prescriptions still were being filled with CFC versions.

Some patients may purposefully be buying up cheaper CFC inhalers before the sales ban. But many patients don’t see a lung specialist, or their prescription may not expire until next year so they haven’t been seen recently enough to be told.

Reaching the last fraction “is, as you can imagine, a very difficult task,” said Dr. Badrul Chowdhury, FDA’s pulmonary drugs chief. “How to get to somebody who is not tuned in?”

The CFC-free options: GlaxoSmithKline’s Ventolin HFA, Schering Plough’s Proventil HFA and Teva Specialty Pharmaceuticals’ ProAir HFA all contain albuterol. Also, Sepracor’s Xopenex HFA contains the similar medication levalbuterol.

Albuterol inhalers are for emergencies, for quick relief of wheezing. Patients also need daily medication to control their asthma and prevent flare-ups. Someone who is using the albuterol inhaler more than a few times a month isn’t well controlled, and his or her doctor needs to determine why, said Dr. Paul Greenberger of Northwestern University, president-elect of the American Academy of Allergy, Asthma & Immunology.

Here’s the rub: Recent research suggests only one in five children has their asthma under good control; no one knows how many adults do.

The last to go CFC-free will be the poor and uninsured whose asthma is less likely to be controlled, said Dr. Leo, who researches that issue at Michigan’s Center for Managing Chronic Disease.

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