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Health spotlight: Environmental concerns force asthmatics to pay more for life-saving inhalers
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Dr. John Yarbrough talks about switching asthma patients to new inhalers.

To protect the Earth’s thinning ozone layer, millions of asthma patients are being forced to change how they take their medication.

They’ll still be able to take albuterol, the standard "rescue" drug that helps ease the symptoms of an asthma attack. But the propellant that forces the medicine into the lungs will be different.

As of Dec. 31, inhalers that are propelled by chlorofluorocarbons, or CFCs, can no longer be sold in the United States. The reason dates back to the Montreal Protocol, a 1987 international treaty that banned CFCs because they destroy stratospheric ozone.

Without that high-altitude ozone layer, too much ultraviolet radiation would reach the Earth’s surface, putting humans at greater risk for skin cancer. CFCs were long ago phased out from aerosol cans and from refrigerant products such as Freon.

But the makers of asthma drugs were granted a waiver because at the time, there wasn’t a suitable substitute for CFCs in inhalers. Now, however, there’s a propellant called hydrofluoroalkane, or HFA, that works just as well as CFCs.

But switching to HFA-propelled inhalers may take a little adjustment for patients. So the U.S. Food and Drug Administration is urging patients and their doctors to make the change now, rather than waiting until the end of the year.

Dr. John Yarbrough, a Gainesville allergist, said he didn’t wait for prompting from the FDA.

"We’ve been transitioning patients for about a year," he said. "We knew this was going to happen for a long time."

But some patients are postponing the change as long as they can, because it’s going to hit them in the wallet.

"The new (inhalers) are more expensive," Yarbrough said. "People don’t want to pay more for the same drug, with just a different propellant."

Dr. Ronald Beebe, another allergist in Gainesville, said some patients understandably feel they’re being scammed.

"Because of the change to HFA (propellants), the drug companies are saying it’s a new product, even though the drug is the same," he said. "So there’s no generic."

A new brand-name drug can cost 10 times more than its generic counterpart. But FDA spokesman Chris Kelly said the federal agency only regulates drug safety, not prices.

"We cannot control the marketplace," he said.

Beebe said pharmaceutical companies are offering coupons and discounts for asthma patients who can’t afford the new products.

The FDA has approved three new albuterol inhalers: Proair HFA, Proventil HFA and Ventolin HFA. Also, an inhaler that uses levalbuterol, a drug similar to albuterol, is available as Xopenex HFA.

Daily steroid inhalers, which prevent asthma attacks rather than treat them, are not affected by the change in propellants.

Beebe said if more patients took their preventive medication, most would not need to use their albuterol "rescue" inhalers. But because of the cost or inconvenience, many asthma patients avoid taking daily medicine, only to end up in a respiratory crisis.

"Medication compliance is a big problem," Beebe said. "About 5,000 people die of asthma in this country every year."

Patients who don’t like using their inhalers may be even more unhappy with the new HFA ones.

"These inhalers seem to clog up a little more, so patients have to clean them out about once a week," said Yarbrough. "It’s a little frustrating."

Beebe said it’s also hard to tell when an HFA inhaler is empty. Unlike the CFC inhalers, they can’t be submerged in water to test whether there’s any medicine left.

"And most inhalers don’t have a counter on it (like a car’s odometer), so you can’t look at it and tell how many puffs (doses) you’ve used," Beebe said. "It’s a hassle."

For most, though, switching over to an HFA inhalers means getting used to a different sensory experience.

"It doesn’t feel the same. It’s not as cold (going into the lungs)," Beebe said. "It also doesn’t come out with as much force, so patients think they aren’t getting as much medicine, even though they are."

But he thinks patients will adjust.

"I expect nine out of 10 people will have no problems with it," Beebe said.