There are only a few months to go before HFA inhalers are the only type of inhalers available for people with asthma. Starting in 2009, CFC inhalers will no longer be made. But many people are complaining that the HFA inhalers don't work as well, asthma control is slipping, or they are allergic to some of the ingredients. Oh yes, the new inhalers also cost a lot more -- so much so that some of us are having trouble affording them. There also are no over-the-counter HFA albuterol inhalers. In the face of so many problems, why does the United States continue to move forward with this initiative anyway?
CFC stands for chlorofluorocarbons, which are a chemical propellant used to forcefully push out the mist in medicines like asthma inhalers, as well as personal care products such as deodorant, hairspray, etc. In a worldwide "clean air" agreement passed in the mid-1990s, nations agreed to ban products containing CFCs, because they were judged to be harmful to our ozone layer. Essential medical devices, such as metered dose inhalers, were left out of this legislation at first, while drug makers worked to find replacements.
A replacement was eventually found in the form of hydrofluoroalkanes (HFAs). So, the United States, as well as other countries, agreed to stop making the CFC inhalers by the end of 2008. HFAs are believed to be environmentally-friendly, but they feel, taste, and smell different from CFCs when used in asthma inhalers.
Because of these changes, many people with asthma have raised a concern that the new inhalers are not as effective at controlling asthma. On the other hand, the FDA points out that the new inhalers contain the same active ingredients and have undergone rigorous testing for effectiveness. They also say the HFA propellants produce smaller particles of medication, which are actually better absorbed into the airways. And they claim that any problems with effectiveness are related more to how well people with asthma use their inhalers.
The truth to this issue probably lies somewhere in the middle. It's true that poor MDI technique is probably one of the biggest barriers to asthma control. And the new inhalers require slightly different techniques, which many people may not know about. But it's also true that too many people are complaining about an inability to control their asthma or unexpected allergic reactions to ignore.
At this point in time, it doesn't appear that the decision to ban CFC inhalers is going to change. So, if you're having difficulty maintaining your asthma control with an HFA inhaler, talk with your doctor about the possible alternatives.
Sources:
"FDA Proposing Phase Out of CFCs in Metered-Dose Inhalers for Epinephrine." U.S. Food and Drug Administration; 23 January 08. <http://www.fda.gov/bbs/topics/NEWS/2007/NEW01706.html>
"Topic of the Month - May - Transition to HFA Inhalers." American Academy of Allergy Asthma and Immunology; 23 January 2008. <http://www.aaaai.org/patients/topicofthemonth/0507/>
