http://www.azcentral.com/news/green/...3inhalers.html
Asthma sufferers concerned over new inhalers
by John Faherty - Dec. 3, 2008 12:00 AM
The Arizona Republic
At the end of this month, the inhalers that millions of people with asthma use to control their symptoms will no longer be available.
Those inhalers can prevent an asthma attack or relieve symptoms once one has begun.
The problem is that the inhalers propel the medication with chlorofluorocarbons, which deplete the ozone layer.
Effective Dec. 31, drug companies will no longer be able to manufacture or sell the CFC inhalers.
"This is the first time that an effective medication has been removed from the market in the USA for an environmental issue," said Dr. Ira Feingold of the American College of Allergy, Asthma and Immunology.
The inhalers are being replaced by non-CFC inhalers.
The new inhalers provide the same medicine but with subtle differences.
Those differences have some patient-advocacy groups concerned.
"The big struggle is not the effectiveness of the drug," said Nancy Sander, founder of Allergy and Asthma Network Mothers of Asthmatics. "The problem is education. There was no plan to inform the patients."
The new inhalers use propellants called hydrofluoroalkanes, or HFAs. The three primary differences between the two mechanisms are that the new inhalers:
"? Provide a softer spray, which may lead some patients to think they are not getting their correct dosage.
"? Need to be cleaned more frequently.
"? Are more expensive.
The first two issues should be manageable over time, said Judy Harris, a certified pulmonary nurse practitioner with Phoenix Children's Hospital.
"We started the transition at least a year and a half ago," Harris said. "There was some confusion because the inhaler looked different, and it tasted different. But once we talked people through it, there were no problems."
Four of Melvina Perez's five children have asthma.
"None of my kids have said anything," said Perez, of Phoenix. "The only difference was the color (of the inhaler)."
The importance in the difference in the spray, however, should not be diminished, according to Sander.
"The speed at which you inhale has to be very slow and deliberate," she said. "It's a subtle change, but it can be confusing to patients."
Sander's organization has received calls from patients who believe they were not receiving the medicine they needed.
"This is a big deal when you are needing help trying to breathe," she said.
The cost issue could be the hardest for patients.
The Breathmobile is a Phoenix Children's Hospital recreational vehicle that goes from school to school, treating students and informing patients.
Nurses on the Breathmobile give away most of their medicine but keep track of the lowest costs for inhalers.
They have found that the cost for a generic CFC inhaler is about $22.
The cost for a low-priced new inhaler is $35.
The new inhalers are available as brand-name drugs only. That means they may be more costly under insurance plans that typically have higher co-pay charges for name-brand prescription drugs than generic versions. It will be years before new generic inhalers are available.
Asthma-advocacy groups, like AANMA and ACAAI, have been urging Congress and the Bush administration to demand that the new inhalers be covered equally by insurance companies. That has not happened yet.
A cost increase could be a burden for some families, but Feingold stressed that a patient who is properly managing asthma - with exercise, nutrition and sometimes preventive medicine - should not need to use an inhaler frequently.
A single canister should last months.
"If you are going to take a big hit financially, you are doing something wrong," Feingold said. "You should be in better control."
The four drug companies that distribute the inhalers - GlaxoSmithKline, Schering-Plough, Teva Specialty Pharmaceuticals and Sepracor - all provide coupons and give-away programs to help decrease costs for patients.
The reason for the change in the inhalers goes back to 1987 and the Montreal Protocol on Substances that Deplete the Ozone Layer.
This multinational treaty started the effort to eliminate the production and use of ozone-depleting substances.
The CFCs used in inhalers were permitted until now, in part, because their effect on the environment was minimal and in order to give drug manufacturers enough time to develop alternative propellants.
The new inhalers contain hydrofluoroalkanes as a propellant. HFAs do not harm the ozone.
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