December 2, 2008

Asthma Inhalers Go Green

Get ready asthma sufferers: inhalers go "green" on Dec. 31. This forces patients that use the old-fashioned type to make a more expensive and even more perplexing change.

The medicine that the inhalers use, the albuterol that swiftly unlocks airways in an asthma attack, will not change. However, the chemicals utilized to gust the drug into your lungs is.

There will be no more chlorofluorocarbons, or CFCs, that hurt Earth's ozone layer. At the end of the year, all albuterol inhalers will be filled with the eco-friendly chemical HFA, or hydrofluoroalkane.

The bad news: The new inhalers are about $30 to $60 more than the $5 or $10 for the fading generic CFC inhalers.

Patients also have some learning to do. HFA inhalers are used differently than the old-fashioned ones. The medicines feel and taste unusual, sometimes startling users regardless of doctors' guarantee that it is the same as the old.

"There's still significant confusion," says 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.'"

The change is not really a surprise. The Food and Drug Administration has been warning patients that the change was coming, and lung specialists spent last year giving most of the nation's 20 million asthma patients additional warnings.

However, industry numbers indicate that in mid-November, 20 percent of the albuterol prescriptions are being filled with CFC versions. Many patients are decisively buying the inexpensive CFC inhalers in bulk before the sales ban. Nevertheless, many patients do not regularly see a lung specialist, or their prescription may not expire until next year, and they have not been told of the change yet.

The lack of communication "is, as you can imagine, a very difficult task," says Dr. Bidrul Chowdhury, FDA's pulmonary drugs chief. "How to get to somebody who is not tuned in?"

Inhalers are for emergencies, for fast relief from chronic wheezing. Patients also require regular, daily medication to manage their asthma and stop attacks. People who use the albuterol inhaler several times monthly are not well-controlled, and must figure out why, states Dr. Paul Greenberger of Northwestern University, president-elect of the American Academy of Allergy, Asthma & Immunology.

Here is the reason why: new research implies that only one in five children has their asthma under complete control; there is no record of how many adults do.

Specialists are still concerned that several patients will try to save money with a very old nonprescription inhaler that has a dissimilar drug, epinephrine, best known by the brand name Primatene Mist. These inhalers have ozone-harming CFCs.

National asthma guidelines insist that this kind of self-treatment is really dangerous and not as helpful as albuterol. The government will continue the selling of those over-the-counter inhalers until December 2011 as manufacturers reconfigure the change.

Here is some information that asthma patients need to know about the new inhalers:

There will be a gentler puff as a substitute for the CFC's cold blast of air in the back of the throat. "They are getting their medicine," says Dr. David Rosenstreich of New York's Montefiore Medical Center. "They have to get used to it and be aware that it's working."

The green inhalers can get clogged up easily because HFA makes the drug stickier. Clean the inhaler regularly, following the directions specific to the brand. Also, keep the inhaler dry.

The FDA insists that there are plenty of the new inhalers; it allowed manufacturers several years to acquire plenty prior to the ban. However, they encourage you not to wait in getting your new inhalers. When Eric Stoermer of Ann Arbor, Mich., purchased his new inhaler in August, he had to wait a week for the new inhaler for his 11-year-old son Ethan. Their local drugstore was for the moment out of stock. "I ended up having to hunt around on an emergency basis," Stoermer says. "This is a bad thing to run out of."


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