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The older chlorofluorocarbon (CFC)-containing inhalers will be completely off the market at the end of 2008, but they already are getting harder to find.
Hydroflouroalkane (HFA) inhalers are as effective as CFC inhalers and have the same rate of side effects. However, if they are not used properly, patients will not get the adequate dose. As with older inhalers, it is the technique of using the inhaler that may lead to poor results, not the type of propellant.
The following are the important differences between HFA and CFC inhalers:
- HFA inhalers must be primed by pumping three to four times. This was not critical with the older CFC inhalers. Each brand of the newer inhaler requires a different frequency of priming: Proair (TEVA Specialty Pharmaceuticals, Horsham, PA) requires three priming sprays, while Proventil (Shering-Plough, Kenilworth, NJ) and Ventolin HFA (GlaxoSmithKline, Research Triangle Park, NC) require four. Xopenex HFA (Sepracor, Marlborough, MA) requires four sprays into the air for priming,and four repriming sprays are recommended if the inhaler has not been used for more than three days.
- HFA inhalers have a weaker spray, and patients may think it is not working. CFC-based inhalers used to deliver a powerful force, which caused a feeling of the airway being pushed open; the newer ones provide a warm, soft mist that also has a distinct taste.
- HFA inhalers require a slower inhale.
- HFA inhaler medication is stickier and will clog the inhaler hole, reducing the amount of medication the spray delivers. Cleaning instructions (once weekly) are identical for all inhalers: The mouthpiece should be cleaned once weekly by running warm water through the top and bottom for 30 seconds (remove the metal canister first) and then shaking vigorously to remove excess water. This should be followed by air drying overnight. As with CFC-based inhalers, the metal canisters should never be submerged in water or allowed to get wet.
- HFA inhalers cost more, because it is too soon for generic equivalents to be available. Generic versions should emerge, but it could take several years. Meanwhile, many of the pharmaceuticals are offering discounts, coupons, and other financial assistance for people purchasing inhalers. There also are important differences among the brands: ProAir has the softest spray. Only Ventolin has a dose counter, which helps users keep track of how much medication is left. Proventil HFA, Proair HFA, Ventolin HFA, and Xopenex HFA have 200 doses per canister. Maxair Autohaler (Graceway Pharmaceuticals, Bristol, TN) has 400 doses per canister.
FDA Information on the Elimination of Chlorofluorocarbon-Containing Albuterol Metered-Dose Inhalers and Other Ozone-Depleting Drug Products |
