HFA Inhalers Really Grind My Gears

I can remember it like yesterday, my last puff from my CFC MDI albuterol inhaler, it was that cold consistent blast of life my body so desperately needed. I’ve had severe asthma my entire life, so I can say that over the years I have learned what products work for me the best in preventing or stopping an asthma attack. However, the FDA stepped in and last year CFC MDI inhalers were banned in the United States because of the clean air act. Many people out there might be wondering, “What’s the big deal, there obviously is something else out there that’s just as effective and good for use if the government is stepping in and banning one product.” My answer is yes there is another product, how useful it is where I my gears get grinded.

For those who started reading this and are wondering what CFC MDI is its chloroflurocarbon metered-dose inhaler. Albuterol needs a carrier compound to help in delivering it to the lungs, so CFC was used for more than 50 years. The change of the CFC MDI comes after the Montreal Protocol on Substances That Deplete the Ozone Layer (MPSTDOL) met and decided that these inhalers are not environmentally friendly and can affect the ozone. However, the MPSTDOL looked at CFCs as a whole and not individually. CFCs were used in many other things like fire extinguishers, air conditioners, and industrial refrigerants besides just their medical use mention here. So CFCs were taken as a whole into consideration and decided upon the need to replace them with something more environmentally friendly…keywords: environmentally friendly.

HFAs (hydrofluoralkane) are the new kid in town that’s taking over CFCs. HFAs haven’t been around for very long but the FDA approved the cutting of CFCs in 2005 so testing of the HFAs hasn’t been going on for as long as the CFCs. This may not be a crucial part the changing over but in 2008 HFAs were only making up 5-10% of the albuterol sales. With doctors fully knowing that a change was coming, why wouldn’t they get their patients ready for the change? Now there isn’t any information on why doctors didn’t but it just seems odd to me that they didn’t inform or ready their patients for the change and I just wanted to point it out.

Now in the journal article “Final Count Down to HFA Albuterol Inhalers: Are We Ready as Yet?” there is a nice table that I can not find a way to place here that list which HFA or CFC is better at. When I look at this table it is pretty equal across the board on which is the better delivery method except for the fact that in the paper they consider the CFC inhalers and environmentally unfriendly due to the previous studies on the whole group of CFCs. That grinds my gears because it obviously gives the HFA an overall better look.

The HFA is considered a better steroid because it is smaller and can deliver the medicine deeper into the lungs unlike the bulky CFC. Now asthma attacks can occur at different levels in asthmatics lungs. For me I know that the majority of my asthma attacks start in my upper lungs and spread down to the smaller air sacs. Because of this the reaction my body receives from the HFA inhalers is delayed and I feel the need to keep puffing on my inhaler. Some may think that that’s not a problem but it definitely is when looking at the cost of the product.

HFA inhalers cost anywhere from $30-$60, while the CFC inhalers cost $5-$25. So now for me to feel like I’m protected against my asthma I spend more money, but I never seem to get my monies worth out of an inhaler because it doesn’t seem to last and insurance has to be considered here too. Insurance will only allow you to purchase one inhaler a month. Before with the CFC inhalers I could go three months without replacing my inhaler, and now with the HFA inhaler I can barely make it a month. For me this is frustrating since my asthma is in the severe category and I need to be carrying an inhaler with me at times even if the inhaler doesn’t seem to be working properly.

These new HFA inhalers need to be cleaned out weekly or steroid builds up and clogs the spray hole. I have been stuck before when I needed the inhaler badly and it hasn’t worked because I used it for two days and the spray hole was clogged. Now I haven’t seen any studies out there that have looked at the correlation between asthma deaths to those due to improper maintenance of inhaler but it would be interesting to see done. Now with the CFC I never had a problem with clogging. When the HFC clogs it limits the dose received. Its frustrating that I just now saw that it needs to be cleaned weekly. I was never told this and it was never apparent in the material given with the inhaler or made clear. I feel like that the cleaning of the inhaler so that it can be used properly would be very important to tell patients.

If all of that hasn’t grinded my gears enough I voiced my concerns of the new inhalers with my family doctor, who just so happens to be one of the people that gets to review all inhalers and their design and ease of use. It was refreshing that he felt the same about the new inhalers and is currently trying to get them reversed back to the CFC MDI albuterol inhalers. He provided me with some aggravating information on the CFC inhalers that they have been provided within his focus group. One plane flying from L.A. to NYC produces more harm to the environment and ozone than did all the CFC inhalers being used do in a complete year. That stat with the obvious problems that can occur and the cost of HFAs really grinds my gears!

1.Butt, Ahmed T et al. Final Count Down to HFA Albuterol Inhalers: Are We Ready as Yet?. Clinical Pediatrics. Vol 48. March 2009.
2. Evans, Jeff. Switch to HFA-propelled albuterol inhalers now, FDA advisory urges. Entrepreneur. August 2008.