By now many of you are aware of the arrival of HFA inhalers that represent the new environmental friendly carriers for aerosol inhalers. Three new brands of albuterol are currently available as Proair HFA, Proventil HFA, and Ventolin HFA.** Xopenex HFA** is a purified form of albuterol that has potentially fewer side effects and in some studies increased effectiveness compared to older brands of albuterol.
All of these inhalers are considered reliever, or rescue, inhalers and are indicated for the relief of asthma symptoms and prevention of exercise induced asthma. These inhalers have the same roles in asthma treatment and similar side effect profiles (although as stated Xopenex HFA may have fewer side effects than the others) but there are some differences between them you should be aware of.
Proair HFA inhaler requires** 3** priming sprays before taking the first puff. It is also recommended that** 3** priming sprays be done again if the inhaler has not been used for more than 2 weeks.
The mouthpiece should be cleaned once weekly by running warm water through the top and bottom for 30 seconds (after removing the metal canister) and then shaking vigorously, to remove excess water, followed by air drying over night.
If Proair HFA is required before drying is complete, you should spray a couple of sprays into the air (away from the face) before inhaling your puffs. Rewashing and drying again is recommended if you have to use it before fully dry.
Proventil HFA has similar patient instructions but** 4** priming sprays are recommended. As well, if the inhaler is not used for more than 2 weeks,** 4** sprays into the air (just like priming, spray away from the face) are again recommended.
The same washing instructions recommended for Proair HFA are established for Proventil HFA.
Ventolin HFA requires** 4** priming sprays before initial use and if not used for 2 weeks. Additionally,** 4** priming sprays are advised if the inhaler is dropped. The makers of Ventolin HFA also recommend that the inhaler be stored with the mouthpiece down at all times.
Cleaning instructions for Ventolin HFA are the same as the above inhalers (once weekly). You are recommended to do 1 re-priming spray if you have to use the inhaler before it is completely dry (then rewash and allow full drying as previously mentioned).
If you are on Xopenex HFA the above priming and cleaning instructions are similar but 4 sprays into the air for priming are recommended;** 4** re-priming sprays are recommended if the inhaler has not been used for more than three days. Cleaning instructions (once weekly) are identical to Proair HFA and Proventil HFA.
What about Maxair Autohaler?
Maxair Autohaler has a unique breath-actuated mouthpiece which makes it much easier to use. It does not have an available HFA associated brand. The makers of Maxair have been given additional time to adapt their product to an HFA form. The current brand (which is still available) has CFC (chlorofluorocarbon) which has been associated with contributing to damage of the stratospheric ozone layer.
Maxair Autohaler requires 2 priming sprays when used for the first time and if not used for** 48 hrs**. The procedure for priming is unique and should be further reviewed in detail by reading the package insert (or going to the Maxair link below).
Cleaning this (Maxair) inhaler is also unique in that the metal canister should never removed. A cotton tipped swab is used to clean around the nozzle while holding the inhaler upside down (see package details or the link below).
All the above inhalers are forms of aerosols which should be shaken vigorously before using and require full exhalation (completely empty lungs first) before inhaling. Proventil HFA, Proair HFA, Ventolin HFA and Xopenex HFA have 200 doses per canister.
Maxair Autohaler has 400 doses per canister.
Ventolin HFA is the only reliever inhaler that has a dose counter attached to the mouthpiece.
Remember: The metal canisters in these inhalers should never be submerged in water or allowed to get wet (avoid letting them go through a washer or dryer cycle by being left in your pocket).
The costs of these inhalers vary depending on their own individual wholesale / retail cost and degree of insurance coverage (the latter being most important to the insured patient). No particular brand has any proven superior benefit in asthma treatment over another.
Correct inhalation technique, appropriate use (for relief of asthma symptoms or prevention of exercise induced asthma) and proper care and priming are important for achieving good results.
Also remember that reliever inhalers only help to reduce asthma symptoms but do not control asthma or reduce inflammation. Other types of inhalers (controllers) are available and should be used to manage persistent asthma (higher level of severity than mild asthma). Controller inhalers are used on a regular basis under the doctor’s orders.
Board Certified Allergist and Asthma Specialist