Ozone friendly inhalers causing new problems
January 19, 2009
By David Hayes
Sherry Williams has lived with her asthma symptoms since her college days 30 years ago. She’s been putting up with her new inhaler since last July.
“I was switched to one of the new ones after I got a thing from my insurance company,” she said. “I had no choice.”Williams, 50, used metered-dose inhalers that used chlorofluorocarbons, more commonly known as CFCs, to propel the medicine from the canister into her lungs, mostly during asthmatic emergencies.
“I used to get really bad seasonal allergies. I took shots for years,” the plateau resident recalled. “The asthma just progressively got worse as I aged.”
Williams, one of an estimated 20 million asthma sufferers in the United States, added that through regular medications, her asthma was just getting better when the change in inhalers was mandated.
CFC inhalers were phased out after the U.S. agreed to participate in the 1987 Montreal Protocol. The international treaty banned substances damaging the ozone layer. Drug manufacturers since have developed “green” inhalers. Three new inhalers were developed to deliver the albuterol medication that uses a new more environmentally friendly propellant, hydrofluoroalkane, more commonly known as HFA — Ventolin, Proventil and ProAir, all approved by the Food and Drug Administration.
Williams’ doctor Todd Freudenberger put her on Proventil. Although the new inhalers work as well or better than the old CFC delivery systems, Freudenberger admitted that there were several major issues since the implementation.
First, he said, the medication is no longer generic, which used to keep costs low.
“The old generic was about $15 or $16,” said Freudenberger, a pulmonary and critical care specialist at Overlake Hospital in Bellevue. “The newer HFAs are probably twice that.”
Some health groups are reporting the costs are as much as $60. Also, most insurance plans only cover one of the three types, Freudenberger added.
“If people tend to do better with one type over another, then that just adds hoops they have to jump through to get the one best for them,” he said.
Users have also expressed concerns that the new propellant delivers the medication in a softer puff, he said. So, many patients feel like they’re not getting the correct prescribed amount.
“I have to reassure them they are getting the right medication amount. The HFA works probably as good or better than the old CFCs,” Freudenberger said.
Proper use of the HFA inhalers is also causing problems. The new ones have to be primed first, spraying up to as many as four quick spurts into the air, if they haven’t been used in a couple of weeks. Also, they carry a larger risk of clogging.
“If you don’t clean them regularly, they won’t dispense properly,” Williams said. “I carry one in my purse and in my car for emergencies. If I don’t take them out and clean them, then they won’t give out the right amount.”
Finally, Freudenberger said many patients can’t tell when the new inhalers are actually empty. With the CFC inhaler, patients could get a good feel for when there was still medication in the container.
“If you moved them back and forth, you could hear if any medication remained,” he said. “Also, you could put it in water. If it floated, it was empty.”
You can’t do either with the HFAs. When the medication is spent, there still remains some propellant. One of the containers, Ventolin, actually comes with a counter that helps patients keep track of how much is left. But again, not all insurance companies pay for Ventolin.
Like many asthmatics, Williams said she isn’t convinced the change was needed in the first place.
“I certainly care about the ozone layer, but I think breathing is more important to me,” she said. “Plus, I don’t like the fact they crammed the switch down our throats. But I deal with it.”
On the Web
For more information about the new inhalers or about asthma, go to:
-American Lung Association www.lungusa.org
-National Library of Medicine
Reach Reporter David Hayes at 392-6434, ext. 237, or firstname.lastname@example.org. Comment on this story at www.issaquahpress.com.