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HFA inhalers don't work. I know, I've tried them. You point out they need to be primed 4 times first. I assume that means 4 puffs into the air. So they cost more to begin with and contained 200 doses divided by 5 = 40 doses per container. I'm amazed you report this with a straight face.
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
I'm a 35 yr old male who was diagnosed whith athletic induced asthma in my early 20's. I'm concerned about my asthma lately due to the fact that it has become progressively worse in the last year. I have used Flovent, albuterol, and Singulair 10mg to help control my asthma throughout the yrs, but I mostly relied on my albuterol to get me through the day (once or twice a day). When my asthma would flair up I would start using my Singulair until I thought it was under control (maybe a week or so). I never really used the Flovent until this year when my asthma flaired up, and I could not control it with the albuterol and Singulair. I found out how much Flovent really helps and reduces the amount of albuterol that I need.I've been laid off and now I don't have insurance and it's to expensive for me to buy the medication so I only use albuterol and Singulair. Last month I went to get a refill on my meds Singulair and albuterol before I ran out, but I was given the new Proventil HFA albuterol inhaler instead of the CFC albuterol inhaler (Armstrong). In using the new inhaler my asthma seemed to get progressively worse over a few weeks of use to the point I was using it every 2-3 hours. I was still using the Singulair. That said, I went back to my old inhaler and continued to use the Singulair, as well as using some supplements and tea. Over the next 10 days or so, my asthma receded and I had stopped the use of my albuterol inhaler for a couple of days. I then went to my Pharmacist and asked her if I could have been allergic to the Proventil HFA. She said more than likely no, but she checked the ingredients to see if there were any differences between the two albuterols. No differences. She called my Dr. to get a different brand...Proair which I have used a couple of other times. Now my asthma has flaired up again, with no surprise after not using an inhaler. I have begun to use the Proair HFA and again it seems that I'm begining to use it more often than I would have with the CFC inhaler. I am still using the Singulair and supplements. Is it possible that the HFA gas hydroflouroalkane-134a is triggering the flair up and is there an alternitive to the HFA 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
I still don't understand why the necessity to change from the CFC to the HFA propellant. There couldn't have been enough CFC in an inhaler to make any difference to the environment. Another case of the environmentalists having their way without any science to back it up? My new HFA inhaler cost three times as much and my perception is that I'm not getting as much therapeutic benefit from it.
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
To start with, HFA albuterol inhalers cost 3 times as much.
As you have repeatedly and correctly said, albuterol inhalers are intended to be used as rescue medication only, with steroid inhalers used for daily maintenance use. The HFA albuterol inhalers fail utterly in that role. (It's interesting that HFA is a much more successful propellant with the daily steriod inhalers, than with albuterol rescue inhalers.) The more onerous priming and cleaning requirements mean that your rescue inhaler may not be ready to rescue you from an attack. And the previous convenient practice of keeping a spare inhaler in your gym bag or desk drawer at work, can no longer be used - so you might not have any inhaler at all exactly when you need it. The advice to not put an HFA albuterol inhaler your pocket because it might get wet is another reason why you won't have any inhaler exactly when you need it.
The "required" practice of patients counting how many doses have been used from an inhaler is simply ridiculous. Nobody, nobody does this. Has my current inhaler been used 200 times? I have absolutely no idea. Another fatal shortcoming in a "rescue" medication.
The HFA propellant results in slower relief than the CFC propellant. An asthma attack will last longer when treated with HFA-propelled albuterol. "Rescue" should be fast; HFA-propelled albuterol is slow.
My worst asthma is in the autumn, and this fall has been my first season using HFA inhalers exclusively. My overall asthma control has worsened significantly, with attacks being more severe and longer lasting, (though not more frequent), a situation I am reviewing with my doctor. I'm just glad autumn is now over, and winter is here with its clean pollen-free air. Hopefully CFC inhalers will be back by next autumn.
This is a massive fraud that is killing people, mostly for drug company profits. I just hope I won't be next, when I'm away from home and my HFA albuterol inhaler fails me.
Hi Wheezer,
Many of the points you made are true. The new HFA inhalers are about triple the expense of the old HFA types. They are certainly more labor intensive regarding the cleaning and priming characteristics. Yes, a few more seconds may enhance getting the full dose, regarding priming.
But (regarding some of your other points):
-Many of my patients are able to get multiple inhalers to keep in different places (it depends on your insurance).
-All reliever inhalers (the term interchangeable with rescue inhalers) are not the same. One brand of HFA has a dose counter (Ventolin). Maxair continues to be available as a CFC containing inhaler but is not has inexpensive as the old generic albuterol inhaler (but Maxair canisters have 400 doses in them).
-As an asthma and allergy specialist I see a large number of asthma patients. The majority of them find the HFA inhalers very fitting to their needs as reliever medication (including many that previously had the CFC-albuterol inhalers). Of course there are exceptions, but if asthma control is addressed as the primary focus, relief of active asthma symptoms becomes less frequent need.
-Many of my patients carry their inhalers in their pocket or in bags. As long as the cap is kept on it should be fine. Stick it in a sealed plastic baggie if you think moisture may be a problem.
-Finally, I am sorry your experience with these requisite new HFA inhalers was so awful last fall. I think you need discuss your concerns with your doctor. He/she should sit down with you and analyze how to approach the next fall season differently. First try to get a better understanding of why your asthma requires so much more relief in the fall season (ragweed, molds spore other triggers?).
Best to you,
J. Thompson, MD
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