June 17, 2008

Change in Inhalers Frustrates at First

By Karen Shideler, The Wichita Eagle, Kan.

Jun. 17--When Andrea McClellan of Wichita switched asthma inhalers earlier this year, she felt as if the new one didn't work.

It's a common complaint, say Wichita pharmacist Liz Hicks and Hutchinson allergist Teri Lower, who have heard from scores of patients.

The problem: Inhaler manufacturers are switching the propellant used to push albuterol into patients' lungs. The change makes the inhalers work differently, taste different and cost more.

It's a change mandated by the federal government and one that must be completed by the end of 2008.

"It's because we're trying to protect the ozone layer," Lower said.

Older inhalers use chlorofluorocarbon to propel the medication. For the most part, chlorofluorocarbon -- or CFC -- has been banned in consumer aerosols because of its effect on ozone. But it has been allowed for what the Food and Drug Administration considers "essential medical uses."

At the FDA's urging, manufacturers began switching to a new propellant called hydrofluoroalkane -- or HFA -- a couple of years ago. Now, the FDA says, enough alternatives exist to make CFC no longer necessary in albuterol inhalers.

The FDA issued a public advisory May 30, alerting patients, caregivers and physicians that it's time to make the switch if they haven't already.

The change may be good for the ozone, but it has been bad for some patients, at least at first.

HFA has less taste and feels softer, Lower said.

Hicks said patients are "convinced they're not getting the right dose."

McClellan said, "When I first did the switch, I just felt like it wasn't working."

Her mother still uses a CFC inhaler, and McClellan regularly used hers.

With time, McClellan has gotten used to her HFA inhaler. If she uses her mother's now, it "feels like it's doing nothing compared to the new inhaler," she said.

McClellan switched insurance plans at the same time she switched inhalers, so she's not sure of the cost effect.

No generics

But Hicks and Lower said most patients have seen costs go up because the change in propellants made all inhalers "brand names" again; no generics will be available for a few years.

"Everybody's paying a bunch more," Hicks said.

The new inhalers also seem to clog more easily than the old ones. McClellan said her son's school nurse called several times to say the inhaler wasn't working. It was, but needed cleaning.

McClellan said the mouthpiece needs to be cleaned every three to five days to keep it working correctly.

Hicks said patients have expressed concerns about CFC's effect on their lungs, asking, "If it's bad for the environment, what's it been doing to my lungs all these years?"

She tells them that CFC's effect is cumulative worldwide: "This is a global problem, it's not a personal problem."

Reach Karen Shideler at 316-268-6674 or [email protected]


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