December 2, 2008 in Nation/World

Deadline nears for switch to ‘green’ asthma inhalers

By LAURAN NEERGAARD Associated Press

Many inhalers CFC-free

The most-used daily medications to prevent asthma attacks already are CFC-free, and all albuterol inhalers – the kind used to treat attacks – must be by Dec. 31.

The Food and Drug Administration has proposed December 2009 as the deadline for seven prescription-only inhalers to either go CFC-free or quit selling. They include:

•Cromolyn and nedocromil, a separate family of drugs used to prevent wheezing, often in connection with allergy exposure.

•Combivent, a combination of albuterol and ipratropium commonly used by patients with chronic obstructive pulmonary disease or COPD.

•Two additional quick-acting alternatives to albuterol, metaproterenol and pirbuterol.

•And two corticosteroids, inflammation-reducing drugs, called flunisolide and triamcinolone.

Also, December 2011 is FDA’s final deadline for a nonprescription CFC-containing inhaler, epinephrine, to end sales or go CFC-free.

WASHINGTON – Last warning: Asthma inhalers go “green” on Dec. 31, forcing patients still using the old-fashioned kind to make a pricey and even confusing switch.

The medicine inside these rescue inhalers – the albuterol that quickly opens airways during an asthma attack – isn’t changing. But the chemicals used to puff that drug into your lungs are.

No more chlorofluorocarbons, or CFCs, that damage Earth’s protective ozone layer. By year’s end, all albuterol inhalers must be powered by the more eco-friendly chemical HFA, or hydrofluoroalkane.

The down side: The new inhalers cost more, $30 to $60 compared to as little as $5 or $10 for the disappearing generic CFC inhalers.

And patients face a learning curve. HFA inhalers must be used differently than the old-fashioned kind. The medicine feels and tastes different, sometimes alarming new users despite doctors’ assurances that it works just as well.

“There’s still significant confusion,” says Dr. Harvey Leo of the University of Michigan’s C.S. Mott Children’s Hospital. “Patients will tell you, ‘I don’t feel the puff anymore.’ ”

Calls from parents unsure how to use the new inhalers, or even what they are, have increased in the past two months as more drugstores run out of CFC-powered inhalers and automatically switch people who’d been expecting a mere refill, he adds.

The Food and Drug Administration has long warned it was coming, and lung specialists have spent the past year easing many of the nation’s 20 million asthma patients into it. But industry figures show in mid-November, 20 percent of all albuterol prescriptions were being filled with CFC versions.

Some patients may purposefully be buying up cheaper CFC inhalers before the sales ban. But many patients don’t see a lung specialist, or their prescription may not expire until next year so they haven’t been seen recently enough to be told.

Reaching the last fraction “is, as you can imagine, a very difficult task,” says Dr. Bidrul Chowdhury, FDA’s pulmonary drugs chief.

The CFC-free options: GlaxoSmithKline’s Ventolin HFA, Schering Plough’s Proventil HFA and Teva Specialty Pharmaceuticals’ ProAir HFA all contain albuterol. Also, Sepracor’s Xopenex HFA contains the similar medication levalbuterol.

Albuterol inhalers are for emergencies, for quick relief of wheezing. Patients also need daily medication to control their asthma and prevent flare-ups. Someone who’s using the albuterol inhaler more than a few times a month isn’t well-controlled, and his or her doctor needs to determine why, stresses Dr. Paul Greenberger of Northwestern University, president-elect of the American Academy of Allergy, Asthma & Immunology.

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