The end is near for CFC-propelled inhalers

With the deadline for the transition to HFA-propelled inhalers less than six months away, millions of patients still rely on the older devices.

By Susan J. Landers, AMNews staff. July 14, 2008.

Washington -- The clock is running down for albuterol metered-dose inhalers that rely on the ozone-depleting propellant chlorofluorocarbon, or CFC. Doctors are being urged to help the many patients who still use them to switch to hydrofluoroalkane, or HFA, devices before Dec. 31.

That will be the last day that the CFC inhalers can be sold in the U.S.

Patients should be reassured that the albuterol inhalers utilizing the more environmentally friendly HFA propellant will contain the same medicine as did CFC devices and have been shown to be safe and effective in studies. But important differences exist, according to the Food and Drug Administration and asthma and allergy specialists.

"They taste different. The mix may be softer. HFA albuterol inhalers may clog," said Badrul Chowdhury, MD, PhD, director of the FDA's division of pulmonary and allergy drug products, during a May 30 briefing.

Millions of patients still use the CFC inhalers. Dr. Chowdhury estimated that about 65% of albuterol in the U.S. is HFA-propelled and the rest is CFC-propelled.

Albuterol is one of the top 10 prescribed medications in the country with approximately 52 million prescriptions written every year, he said. The drugs are used as quick-relief "rescue" medications for wheezing and shortness of breath in patients with asthma and chronic obstructive pulmonary disease.

Some patients would very much like to hold on to their CFC inhalers. They argue that the HFA inhalers, which have been on the market for about a decade, cause more adverse reactions -- a charge disputed by the FDA. They also say HFA versions are more expensive than the older devices -- a point on which all agree.