HFA Inhaler Switch:

Of Hummers and Asthma

Forced Switch to HFA Inhalers Once Again Shows How the FDA Sets Priorities

by Josh Day

I have asthma.

Thankfully, I'm one of the lucky ones whose childhood disorder has turned into a slightly annoying ailment that usually doesn't bother me. Even so, I have an inhaler for emergencies.

Turns out our trusted, tried-and-true inhalers are being phased out.

Here's the story...

The Connecticut Pharmacists Association states:

The U.S. Food and Drug Administration (FDA) has mandated the removal of the exemption granted to chlorofluorocarbon-based (CFC) metered-dose albuterol inhalers, and the transition to environmentally-friendly hydrofluoroalkane-based (HFA) albuterol inhalers by December 31, 2008.

During this important transition, the supply of CFC-based asthma inhalers will gradually decline, while supplies of HFA-based inhalers are expected to increase. (CPA)

And now straight from the FDA's site...

Although chlorofluorocarbons (CFCs) in medicines are safe for patients to inhale, they are harmful to the environment. CFCs reduce the amount of ozone in the ozone layer that surrounds the earth and protects the earth against the sun's harmful rays. The loss of ozone can increase the risk of skin cancer, cataracts, and other health problems. Replacing the CFCs in your metered dose inhaler with another substance, called HFA, will make the environment safer for everyone. This change has already begun and will continue, as more ozone-friendly choices become readily available. (fda.gov)

If you're asthmatic, odds are you've known about this phase-out for some time now. I bet a good number of you have stocked up on your old inhalers as well.

My cousin was even advised by her doctor to stock up.

"Environmental" issues aside, why is this happening?

Marianne Lavelle of US News & World Report writes:

Like many asthma sufferers, Marty Marth was surprised to hear a news report months ago that her medication was being phased out because of its effect on the environment. [...] Instead of paying $22 for generic albuterol, a 26-year-old drug that relaxes airway muscles, Marth faced a $148 bill for two different medicines.

The first was albuterol with a new ozone-friendly propellant, sold for $36 under the brand name ProAir HFA. Even more damaging to her pocketbook was the second medication, Flovent HFA, with a hefty monthly cost of $112; her doctor had used the Food and Drug Administration-driven switch as an opportunity to add that inhaled anti-inflammatory, to be used daily to reduce the need for albuterol, to her therapy plan. (Asthma's New Expense: US News & World Report)

Lavelle goes on:

That translates into a windfall for GlaxoSmithKline, Schering-Plough, Sepracor, and Teva Specialty Pharmaceuticals, the four manufacturers of CFC-free inhalers. More difficult to quantify are the additional brand-name drug sales that may occur as an indirect consequence of the FDA action, as doctors review patients' asthma control plans and—as in Marth's case—prescribe one of several newer preventive medications that are far more expensive than albuterol. (Asthma's New Expense: US News & World Report)

It gets worse. Turns out this is part of a larger allopathic push to get people off medications that have worked for decades and get them onto newer, astronomically more expensive, multiple drugs, all under the vague umbrella of "preventive care."

Of course, once the big dogs make a ruling in the yard, the rest will fall in line too, even the smaller dogs that ostensibly exist to protect the patient:

Two big patient advocacy groups, the American Lung Association and Allergy and Asthma Network Mothers of Asthmatics, support the FDA decision—and in fact helped spur it by filing a 2003 petition requesting CFC withdrawal.

Both groups undertook CFC public awareness programs sponsored by drug companies. The ALA's "Time to Make the Switch" campaign was underwritten with $1 million from Teva, maker of ProAir HFA. The AANMA promotes "Smart Moves to an HFA Inhaler," sponsored by Sepracor. That company sells the albuterol-like drug levalbuterol as Xopenex HFA. (Asthma's New Expense: US News & World Report)

I've used the new HFA inhaler and it doesn't work nearly as well as the CFC variety for instant relief. At the time I didn't even know about this "switch" to the new drug. The chassis and means of triggering the inhaler have changed several times throughout my life so I just figured it was a new model with the same propellant. Wrong.

And you know what? HFA inhalers have a much shorter shelf life than the old CFC variety. It also will spoil in any kind of humid environment and requires a lot more maintenance.

I've gone back to doing what I did in college when the odd asthma attack came calling. I draw a hot shower and breathe in the steam. This natural asthma aid isn't as fast as the old CFC blast of air, but it always helps me and it doesn't cost me a dime.

If you are a mild asthmatic who only seldom uses an inhaler, I encourage you to visit our asthma articles here.

Works cited:

http://www.ctpharmacists.org/i4a/pages/index.cfm?pageid=3488
http://www.fda.gov/cder/consumerinfo/metered-dose-inhaler-2pge.htm
http://health.usnews.com/usnews/health/articles/070819/27asthma.htm