- FRIDAY, May 30 (HealthDay News) — Asthma inhalers that contain
the drug albuterol to relax the airways also contain chemicals that harm
the ozone layer. And these inhalers won't be available after this year, so
U.S. health officials are urging patients to switch to alternative
inhalers now.

Chlorofluorocarbons, or CFCs, are widely used to propel inhaled drugs
into the lungs. However, products containing CFCs are being phased out,
because the chemicals damage the Earth's protective ozone layer. CFC
inhalers are being replaced by inhalers powered by HFAs, or
hydrofluoroalkanes, which are ozone-friendly.

The change to HFA-powered inhalers has been in the works for several
years, but the FDA issued an advisory on Friday, urging patients still
using CFC inhalers to switch now. Inhalers containing CFCs will not be
available after Dec. 31.

FDA officials said people with respiratory problems, such as asthma and
chronic obstructive pulmonary disease, may need some time to acclimate to
HFA-based inhalers.

“There are 52 million prescriptions written for albuterol inhalers each
year in the United States,” Dr. Badrul Chowdhury, director of the U.S.
Food and Drug Administration's Division of Pulmonary and Allergy Products,
said during a teleconference. Albuterol is used to treat shortness of
breath in people with asthma and chronic obstructive pulmonary disease, he
noted.

Chowdhury said that approximately 65 percent of inhaler users have
already switched to HFA inhalers.

“These new handlers may taste and feel different than the current CFC
inhalers,” he said. “In addition, HFA inhalers may feel softer than CFC
inhalers.”

Also, patients using HFA inhalers will have to prime and clean them to
prevent the buildup of albuterol in the inhalers' nozzle. This buildup
could block the medicine from reaching the lungs, Chowdhury said.

Each HFA inhaler has a different priming mechanism and cleaning and
drying instructions. So, users should carefully read the instructions
before using the inhaler. And HFA inhalers may cost more, because there's
no generic HFA inhaler available yet, Chowdhury said.

Three HFA-propelled albuterol inhalers have been approved by the FDA:
Proair HFA Inhalation Aerosol; Proventil HFA Inhalation Aerosol; and
Ventolin HFA Inhalation Aerosol. Also, an HFA-propelled inhaler containing
levalbuterol, a medicine similar to albuterol, is available as Xopenex HFA
Inhalation Aerosol, the agency said.

Dr. Ira Finegold, chief of the Division of Allergy and Clinical
Immunology at St. Luke's-Roosevelt Hospital Center in New York City,
doesn't see much difference in the effectiveness of the two types of
inhalers. “The end result — if you need it, does it open up your lungs?
Yes, it does,” he said.

However, the changeover will involve some patient education, he said.
“The old medication, CFC albuterol, was really a very nice product,
because the propellant got in your body and came out of your body — it
wasn't absorbed. And remarkably, it is a cleaning agent, so the device was
self-cleaning.”

The new HFA propellant is safe in the body but can clog the inhaler,
Feingold said. “So, after use, these inhalers need to be rinsed out or
they are not going to work correctly,” he said.

“In addition,” Feingold added, “each of the four new inhalers on the
market is different in the number of times you have to prime it. There is
also a little difference in feel and taste.”

The discontinuation of CFC-propelled inhalers is the result of the U.S.
Clean Air Act and an international treaty known as the Montreal Protocol
on Substances That Deplete the Ozone Layer.

Under provisions of this treaty, the United States agreed to stop the
production and importation of substances that damage the ozone layer,
including CFCs, according to the FDA.

More information

For more on inhalers, visit the U.S. Food
and Drug Administration.