New HFA Reliever Inhalers for Asthma- Things You Should Know

Hi Ms. Parker,

I advise you to discuss your concerns with your prescribing doctor. Other people share in your frustration with the new inhalers. Some HFA inhalers have different specifications regarding priming doses (some require fewer than 4 priming sprays and longer intervals between priming). The package insert gives the details. Proventil HFA requires 3 priming sprays initially, and if not used in 2 weeks, for example.

I think your calculation of 40 doses/canister is way off. Most people do not use 160 doses for priming. I don't know why you divided the total number of doses by five.

I try to report the facts along with some opinion. There are many people that so rarely need reliever inhaler, the new formulations don't matter to them. Their controller medications (some of which are also HFA based) diminish the need for rescue medication. That's the goal I strive for, in my patients.

Again, discuss your concerns with your doctor. Perhaps a different brand of HFA inhaler may work better. Maxaire Autohaler has another year before the company has to convert to HFA. I have switched some of my unhappy patients (those unhappy with HFA relievers)

to Maxair, which still contains the old CFC propellant. Maxair must be primed more often but the canisters have 400 doses in them. Unfortunately it may cost more, based on insurance coverage.

Good Luck,

J. Thompson, MD

the new hfa inhalers are far inferior to the old cfc inhalers. please visit our website to learn the facts and to sign our petition to bring back the old cfc inhalers. www.savecfcinhalers.org

jen lee

the national campaign to save cfc inhalers

Hi Justin,

Unfortunately your experience with the new inhalers that are HFA based is not unique. Some of my patients remain convinced that these new reliever inhalers are inferior to the old CFC types. When I hear of such complaints I spend several minutes detailing the importance of priming, cleaning and practicing good inhaler technique. If you are doing all these things correctly and consistently but still having problems, adjustments in medications should be considered.

Suggestions:

Consult your asthma care provider first. There is one brand of CFC inhaler for relief of asthma symptoms still available. Maxair Autohaler is currently not available as HFA. As far as other alternatives to the HFA types, none are available with albuterol as the chief ingredient. Xopenex HFA is a more purified form of albuterol that perhaps may be more effective (but may be more costly).

If you were under my care I would reassess your level of asthma control on Singulair alone (Pulmonary Function Test). If appropriate, I would have you restart an inhaled steroid that is comparable or less costly than Singulair, and after reviewing your response, consider stopping the Singulair (Inhaled steroids are the definitive and preferred controller for treatment of persistent asthma). I would provide you with as many samples as I could to get you started. Nothing wrong with asking your doctor about samples.

I will be posting an article about how to save money on asthma medications soon so stay tuned (www.MyAsthmaCentral.com).

Final Words:

Consult your doctor about your concerns about the inhalers as well as your finances.

Good Luck!

J. Thompson, MD

Thank you for your time and consideration to evaluate my case. Your advice is much appreciated and I look forward to reading your article. I will consult with my Dr. about your suggestions and hopefully we can find somthing that works for me.

Thanks,

Justin

Hi Warren,

I think there are many people that share your concerns and agree with your comments. There are millions of cars and refrigerator units still generating CFCs (from coolants used in the radiators and freezing components) that are obviously more of a factor than aerosol medications.

I think world leaders in environmental science are on the right track but they are starting with really small beans. Guess you have to start somewhere, and medications were an easy target.

Many people feel the new hfa inhalers don't have the same impact as the cfc containing ones. Certainly the force, temperature and other characteristics of the spray are different. The dose of the active drug (albuterol) in each spray is the same.

The majority of my patients don't complain about the response to the HFA reliever inhalers because it is really de-emphasized when asthma is well controlled (meaning it is rarely needed). My major goal is to control the asthma such that albuterol types of inhalers are seldom required.

No doubt the cost difference, not having a generic alternative, is a royal pain for most. Hopefully the brands will compete with each other enough to drive some of the cost down. But this won't be happening soon, and don't expect to see a new generic form for several years. I know, just what you wanted to hear, sorry.

Best Wishes,

J. Thompson, MD