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What's Different About The New HFA Inhalers?

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The HFA inhalers are more expensive because any medication combined with a new propellant is considered a new drug by the FDA.

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By RICHARD F. LOCKEY, MD

Tribune correspondent

Published: January 8, 2009

As of Jan. 1, all albuterol inhalers used by millions of Americans with asthma have gone "green." The replacement of inhalers propelled by chlorofluorocarbons (CFC) with hydrofluoroalkane (HFA)-propelled inhalers was federally mandated because CFCs damage the ozone layer that helps protect us against ultraviolet radiation. Higher levels of ultraviolet radiation cause an increased incidence of skin cancer and cataracts.

Despite advance notice of the transition, the Food and Drug Administration estimates that as many as 40 percent of patients using inhalers have not yet switched over to HFA inhalers.

Like the CFC inhaler it replaces, the HFA device dispenses a short-acting bronchodilator that helps open the airways to provide quick relief for wheezing and shortness of breath. The primary difference between the two is the way albuterol is propelled from the canister into the lungs, but patients will notice certain other differences as well.

For example, the spray from HFA inhalers may taste and feel different than that from CFC inhalers. There's a softer mist and warmer sensation when you inhale the HFA spray. If patients do not feel as much force from the spray, they might assume they are not receiving the medication or not obtaining the appropriate metered dose. This is not true. The same effective dose is introduced into the airway regardless of which inhaler is used.

The HFA inhalers are more expensive because any medication combined with a new propellant is considered a new drug by the FDA. The new albuterol inhalers cost $30 to $60, whereas the CFC inhalers ran about $5 to $25 apiece, according to the American Academy of Allergy Asthma & Immunology. The new HFA inhalers contain 200 puffs, more than enough to last several months for almost everyone whose asthma is well-controlled.

Three of the new inhalers (Proventil HFA, ProAir HFA and Ventolin HFA) dispense albuterol. The fourth (Xopenex) contains levalbuterol, another bronchodilator agent in the same class as albuterol. Work with your physician to determine which inhaler is best for you. You cannot just exchange an existing CFC inhaler for a new HFA one; the pharmacy requires a new prescription.

As with the former quick-relief inhalers, these new HFA inhalers should only be used on an as-needed basis to alleviate asthma symptoms. Bronchodilators do not control asthma; corticosteroids and other medications do that. If you reach for an albuterol inhaler more than once or twice a day (other than for exercise), it may mean your asthma is not optimally controlled.

Follow instructions in the package insert to clean your new HFA inhaler at least once a week - or more frequently, depending on use. If you don't, the inhaler can clog and will not deliver the appropriate amount of medication when activated. Wash the case that holds the canister by running water through the top for approximately 30 seconds. Do not immerse the canister in water. Shake off excess water and let the case dry thoroughly overnight. When it is completely dry, replace the mouthpiece and the canister.

Several organizations offer information on their Web sites about the new inhalers, including the American Academy of Allergy, Asthma & Immunology ( www.aaaai.org) and the Allergy and Asthma Foundation of America ( www.aafa.org).

Dr. Lockey is a professor of medicine, pediatrics and public health at USF Health, where he directs the Division of Allergy and Immunology and holds the Joy McCann Culverhouse Chair in Allergy and Immunology.

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