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New HFA Asthma Inhalers Are Effective But Costly
Posted by Craig on Friday, April 06, 2007
Med Ready Inhaler ToteScience Daily reports that the new hydrofluoroalkane (HFA) asthma inhalers are effective and safe but will come at nearly triple the cost to consumers.

The use of chlorofluorocarbon (CFC) metered-dose inhalers will be prohibited after 2008 because of CFC's ozone-depleting effects.

Albuterol is the seventh most commonly prescribed drug in the United States. About 52 million prescriptions are filled each year, and most contain a generic version of CFC propellant.

A report published in the New England Journal of Medicine predicts that Americans will spend an additional $1.2 billion a year on three patented brands using the HFA propellant (Ventolin, ProAir, and Proventil) until generic versions become available around 2012. Patients will pay an average of $26 more per prescription. That adds about to about $312 more per year. People who have prescription benefit plans will likely face higher co-pays.

There are a few differences with the new HFA inhalers. One brand, for example, has a shelf life of just two months after its protective pouch has been opened, while most CFC inhalers can be stored for 15 to 24 months. Also, only one brand (Ventolin) will come with a counter to track the amount of medicine.

"There isn't any reliable way of estimating when they're going to run out," says Leslie Hendeles, University of Florida professor of pharmacy and pediatrics and consultant to the FDA.

HFA inhalers also tend to clog more easily. To prevent clogging, patients should remove the metal canister and clean the plastic actuators once a week.

HFA inhalers are spew slower and warmer plumes of medicine that CFC inhalers, so some patients may feel that they're not strong enough.

"There undoubtedly will be some people who are absolutely certain it doesn't work as well," Hendeles says, adding that patient education is the key to proper care. However, it's the same drug in both types of inhalers, and they both work fine.

Two brands of the new inhalers contain ethanol (alcohol), which may not be appropriate for some because of religious beliefs. They may also cause false positives on breath alcohol sobriety tests performed by law enforcement officials.

Hendeles notes that CFC inhalers release negligible amounts of the propellant and do not pose a threat to ozone depletion; however, in 1978 the United States and 185 other countries signed the Montreal Protocol, a treaty for the complete withdrawal of all CFC products. CFC inhalers were considered medically necessary until the development of HFA inhalers.

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25 Comments
On 5/10/2007 Arthur Abramson wrote:
Dr. Leslie Hendeles is dead wrong.

The new HFA inhalers do NOT "work fine", (although admittedly, Ventolin works better than Proventil, and they both work MUCH better than the hated Teva/Ivax ProAir- which, sadly, owns most of the market). There seems to be a direct correlation between the amount of ethanol used in the inhaler as an excipient (Ventolin has none, Ivax ProAir has the most) and the number and severity of reported complaints.

Paid hacks like Dr. Leslie Hendeles will have NO CHOICE but to respond by saying that there is not enough ethanol in the inhalers to cause any harm (what else COULD he say?), but before judging for yourself who is right and who is wrong, you might want to read what 500 (and counting) asthma and COPD patients (and a number of health care providers) have to say in this online petition to The Powers That Be:

http://tinyurl.com/3bul5u

Asthma is a disease that disproportionately effects low-income/uninsured people, many of whom did very well with the generic CFC inhalers or the OTC Primatene Mist (many of them are now deteriorating badly due to the Ivax ProAir HFA inhalers) and many of these people simply CAN NOT AFFORD the 300% increase in cost for these GROSSLY inferior inhalers.

This scam perpetrated on thirty million asthmatics was supposedly done to protect the ozone, but Dr. Leslie Hendeles himself admits "that CFC inhalers release negligible amounts of the propellant and do not pose a threat to ozone depletion".

Where would we be without such wonderful, caring physicians as Dr. Leslie Hendeles?

Sincerely,
Arthur Abramson
Co-Founder
The National Organization of Asthma and COPD Patients
aa@premretire.com




nemo
On 5/28/2007 jimmyjamma wrote:
I strongly agree with Arthur Abramsons'comments.As a person who has suffered with asthtma since birth,i would have to say this is bad news.I have used nearly every, if not all ihalers on the shelf to date and the albuterol inhaler has been the most affordable and effective.As a peron with no health benifits it has been a great product.To take it off the shelf because of "false" or unsure ozone depleting effects is both upsetting and devestating to my daily life.
On 5/29/2007 cman wrote:
There was no need to get rid of the CFC inhalers in the first place. Common sense should tell these people that spraying the medication in their lungs won't even have a chance to harm the ozone. Even if someone was dumb enough to go around spraying this medication in the air, according to Dr. Hendeles own statement, it releases "NEGLIGABLE" amounts of CFC. There are FAR worse things harming the ozone than a rescue inhaler that millions of people depend on in order to BREATHE! This is nothing but a financial move by pharmaceutical companies in order to make more profit at the expense (and lives) of millions of asthma sufferers. Shame on the FDA for falling for this “protect the environment” ploy. Do they not know ANYONE who has asthma? The ethanol HFA inhalers cost 3 times as much, and even more importantly, DO NOT WORK! The propellant does not allow the medication to get into the patients lungs where it belongs. People might as well drink a teaspoon of the medicine since all it does is stay in your mouth anyway. To the "experts" to claim its all in "our minds" or that we need to inhale deeper. How about YOU try breathing with your bronchi tubes are clogged with mucus, and see how much of it is really just "in your mind". Or perhaps YOU should try inhaling "deeper" when you can't breathe well to begin with. Dr. Hendeles has no idea what he is talking about or maybe Arthur is correct in suggesting that this so called doctor is nothing but a paid HACK. It’s bad enough that we are going to be forced to pay 3 times for a medication, but it should be a CRIME forcing medication on us that does not even work.
On 6/24/2007 garybirder wrote:
The new Proair asthma inhaler does not work as well as the old ones and only dispenses about 50 doses per container instead of the advertised 200. If someone starts a class action law suit, count me in.
On 7/31/2007 b8k3p wrote:
I don't think that the ProAir HFA works as well as my good ol' generic albuterol inhaler.

I don't feel like I'm getting the right dose of medication to the right places, and I find myself needing to use the medication much too often (about 1 inhaler every 2 weeks).

The prices are ridiculous -- I pay 37.00 each time I have to get another inhaler, because I don't have insurance. It's just ridiculous!
On 10/10/2007 Daniel wrote:
ProAir almost killed me. My doctor failed to mention that upun switching from CFC to HFA that you are supposed to cut your dose in half because the new propellent covers a larger lung area which can cause overdose. So I was taking the ProAir the same way I was taking my ventolin and found myself more and more out of breathe til one day I barely made it to work.
On 10/10/2007 yoop wrote:
There is a NEW PETITION and National Campaign to Save CFC Medical Inhalers. Please sign it to let your voice be heard! The petition is located at the following link along with additional information.

http://tinyurl.com/yphmp4

On 10/13/2007 Gary wrote:
I just read your blurb on HFA inhalers. Two words, the first word is "bull".....

They don't work. I now have them and have measured the effect, and there is none. They are junk. Somebody is going to die using these inhalers. I have ProAir HFA inhalers. Now they cost more and don't work. Great job!!! I use an air flow meter to measure the effect, and I see none using the HFA, but when I use my now illegal CFC inhaler I literally blow the meter off the charts. Great, we are saving two square inches of ozone. Great, in the meantime somebody is going to die using these inhalers.

I am no crack pot. I am a degreed engineer. I have followed the instructions to a T, and tried other methods, none work. They don't work. To have a page that says this is good for people is a plain out and out lie.
On 10/14/2007 NicholeC wrote:
One thing they failed to mention was that it does not spray the same as the old inhaler did. I wound up in the hospital for using it too much because i thought the inhaler was not working. They failed to mention they were switching to so now I pay three times for for an inhaler that does a far worse job.
On 10/20/2007 tom eisenberg wrote:
let's start a class action. Everyone who is in email me or call 212-784-1190. This is crazy.
This new replacement inhaler is terrible and people are going to end up in the hospital or worse. Nothing seems to come out unless I spray it 4 times. This is ridiculous! Seems to me they just wanted an excuse to patent a new drug. How do we get the old albuterol inhaler. Also did I read correctly that this only lasts 2 months. What is going on here, the old albuterol ventolin lasted 2 years. I have mild chronic asthma, especially acute after exercise and I take advair which is very helpful , but I need the albuterol once a day. This is mind boggling, I am glad to find out that other asthmatics feel the same way as me. I said a few times to my wife that something is wrong with this inhaler and now I know that I'm not alone. I'm not a lawyer but we should form a committee to lead a group to get the pharmaceutical company to give us what we need. incredible save the environment and let the asthmatics suffer. this is unbelievable. let me know who else is in. thanks tom
On 10/22/2007 Arthur Abramson wrote:
Tom,

I suggest you read the petition- you can't do a class action lawsuit against the USA or the

Montreal Protocol, but you can get the old inhalers you need (right side of petition) and sign it and file a MedWatch

complaint (right side of petition) and auto-email it to everyone you know.

PETITION LINK:

http://tinyurl.com/yphmp4

Art
National Campaign to Save CFC Inhalers

On 3/24/2008 dionac wrote:
The new inhaler do not work. I have been using the Pro-Air for over six months. I have to use three times as many puffs as the warrick inhaler and I still don't get the same amount of relief. I literally have to sit and take in deep breath for 5-10 minutes have using the inhaler to feel any relief at all. The warrick inhaler provided instant relief after 1-2 puffs. This is struly a dangerous situation. I do not have severe asthma and I cannot image how scaring this limited to no relief can be for someone experiencing a sever attack.
On 3/25/2008 Holly wrote:
My son has severe asthmatic attacks and HFA is NOT working. I have signed the petition but who else can I contact--Congressman--President? Please help. Thanks.
On 5/6/2008 Susan wrote:
I am allergic to the HFA Inhalers - They make my scalp feel like someone left a hot iron on my head & my hair falls out - plus it makes my lungs stick - GOD HELP US ALL
On 7/21/2008 psioncat wrote:
I just had to reregister...is that normal? I just heard got a phone call from the manufacturers of ProAir. They were following up on my MedWatch report. They asked me questions about my experiences with the product & were very thorough. I'm not naive enough to think that anything is going to change anytime soon, but at least they are responding to MedWatch complaints/comments. So if you have not filed your MedWatch report yet, please do so. Who knows, maybe something will come of it.
On 7/23/2008 Susan wrote:
Thanks for the tip about Med Watch - I also had family members sign the surveys - Glad to hear someone is listening to us!
On 9/24/2008 justine wrote:
Can not believe this has happened with inhalers. I have just changed from combievent to the new atrovent HFA. I can not breath and havnt stopped coughing since. God someone is going to die because of this.
On 9/24/2008 Susan wrote:
Justin - sing the petition and file a complaint at the FDA website - we must all stick to together. You could try Foradil and Spirva inhalers instead - they are both powder inhalers no HFA sure have helped me but I have no "rescue" inhaler after the ones I have run out. I've heard there are portable pocket size nebulizers available now - hope to get one of those soon.
On 10/19/2008 Ephraim wrote:
may those who find it necessary to force a sub par inhaler on asthmatics spend one day searching for breath. Let them write their studies under those conditions. Pharmaceutical companies spend their time raping Americans for a buck - now they found one more excuse. Shame on you.
On 10/31/2008 jbird1277 wrote:
Someone please tell me where to sign up to fight this. The new inhalers don't work! I can't breathe!
On 11/13/2008 Susan wrote:
I just received a wonderful email from a website that will be up & running next week www.savecfcinhalers.org that sent me 3 pages of helpful information and a host of places forlast minute purchases of the CFC inhalers. The site is to be up & running next week. We must all sign the petition to save our inhalers & have family members sign on our behalf also - https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm GOOD LUCK EVERYONE
On 12/1/2008 akinney wrote:
I am 33 years old and have never thought that I could drop dead from an asthma attack until I was forced to use this new "Pro-Air" inhaler piece of crap! It is a fraction of the medication at 5 times the cost, but that is the least of my concerns, because when it comes to my having the ability to be able to take a deep breath, or worse case be able to breathe at all period, I would have paid 5 times more for my medication, provided it worked. AND IT IS NOT MY IMAGINATION!!! It simply DOESNT work as well!!!! I am not only angry, but scared for my life. I wake up in the middle of the night not able to breathe, I use this thing every 45 minutes when it should last me up to 4 hours. It tastes terrible and doesn't deliver the medication deeply in to my lungs, and I know how to inhale on the mouth piece, because I've been doing it for 35 years. This is nothing but at opportunity for profit with these pharmacuetical companies and cash to their execs! Where I believe there should be a designated special circle in a very warm place down below for every signle one of them! HELP I DON'T KNOW WHAT I AM GOING TO DO. I there anywhere that I might be able to get my hands on the CFC Inhaler that I know I can count on to breath with?????
On 12/1/2008 akinney wrote:
I am 33 years old and have never thought that I could drop dead from an asthma attack until I was forced to use this new "Pro-Air" inhaler piece of crap! It is a fraction of the medication at 5 times the cost, but that is the least of my concerns, because when it comes to my having the ability to be able to take a deep breath, or worse case be able to breathe at all period, I would have paid 5 times more for my medication, provided it worked. AND IT IS NOT MY IMAGINATION!!! It simply DOESNT work as well!!!! I am not only angry, but scared for my life. I wake up in the middle of the night not able to breathe, I use this thing every 45 minutes when it should last me up to 4 hours. It tastes terrible and doesn't deliver the medication deeply in to my lungs, and I know how to inhale on the mouth piece, because I've been doing it for 35 years. This is nothing but at opportunity for profit with these pharmacuetical companies and cash to their execs! Where I believe there should be a designated special circle in a very warm place down below for every signle one of them! HELP I DON'T KNOW WHAT I AM GOING TO DO. I there anywhere that I might be able to get my hands on the CFC Inhaler that I know I can count on to breath with?????
On 12/8/2008 Susan wrote:
Look at my comments above - here is the website www.savecfcinhalers.org - Also I just received my 1st shipment of CFC Ventorlin inhalers same as albuterol from http://www.alldaychemist.com/<br>Infact I also got an order of Xopenx inhalation solution at 1/2 the price. Hurry & contact them - You can get inhalers for as cheap as $3.33 each - Good Luck!
On 12/14/2008 mo71 wrote:
No, they are not effective for me, in fact they make my asthma worse. I have been using mine for 3 days. Yesterday morning, within seconds after inhaling my second puff of my first and only dose, I accumulated so much mucus in my throat I thought I was going to choke. I want to make a distinction- to those who would say I am simply not using the inhaler properly, please explain how 2 puffs as directed would result in significant mucus production in my airway- enough to get me to drive to my doctor immediately. I am a mild-moderate asthmatic who goes weeks or longer without needing any inhaler-- who has never had a significant amount of mucus as a symptom.<br><br><br>Now I am on Prednisone for 5 days and looking overseas for a CFC inhaler. My old CFC inhaler never failed me, and it just never occurred to me that something safe and effective would get taken off the market for environmental reasons. I am as big a treehugging- dirt-worshipper as the next guy, giving up driving as much as I can, taking public transit and reduced my driving 50%, changed my bulbs, carry reusable grocery bags, buying organic, you name it.... but I really, really like breathing freely and I want to live a long life. I am also a runner, and now I am afraid to run or exercise at all now, knowing I have no lifeline in my pocket. I submitted a report to the FDA site. Thank you so much Susan and the others organizing this, I so appreciate it. one">
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