New ‘rescue’ inhalers draw criticism
New “rescue” asthma inhalers may be environmentally friendly, but not everyone is breathing easily over a government-mandated switch to the new products. For years, albuterol metered-dose inhalers have used chemicals known as chlorofluorocarbons (CFCs) to propel the medicine into asthmatics’ lungs, but CFCs have been linked to depletion of Earth’s protective ozone layer. So, in response to a 1987 environmental treaty to eliminate CFC use, the U.S. Food and Drug Administration (FDA) is requiring inhaler manufacturers to replace CFC with ozone-friendly propellants known as hydrofluoroalkanes (HFAs).
Based on the FDA mandate, all albuterol users must switch to HFA inhalers by Dec. 31, 2008.
For some, the transition, which is already under way, isn’t easy.
The new inhalers taste different, are a little dryer and more powdery, and have a softer spray. This different feel may lead some users to believe they’re not getting an ample dose of their medicine, said pharmacist Walt Lizza, owner of Apothecare Pharmacy in South Union Township.
“To be honest, I like the old ones better,” said Lizza, an asthmatic who has used albuterol more than 20 years. “They’re getting that medicine, even though they don’t feel that medication in their mouth like they used to. They need to know there is a drastic difference between the two. It’s a tough thing to get used to.”
Tom Peckyno, a pharmacist at Jendral’s Pharmacy in Uniontown, said he’s heard similar complaints from some of his customers.
“Patients have said that it’s less effective,” he said. “They may have to modify their technique a little bit. Maybe, for instance, when they’re using it, they need to draw in a little bit slower and make sure they get the complete dose.”
Another difference Lizza pointed out is that the HFA inhalers’ lighter weight makes it more difficult to gauge how much medicine is left in the pressurized canister. And, only one of the new HFAs now available has a counter to tell how many actuations, or puffs, remain.
Each canister contains about 200 actuations, so people using the inhaler every four to six hours daily will go through an entire canister in about 25 days, Lizza said. For these patients, he recommends refilling the prescription every 25 days, even though the canister may not be fully empty.
“You’re just better off having that extra one, because if you are using it as a rescue inhaler, you don’t want to be caught without it,” he said.
Perhaps the biggest difference between the inhalers, however, is the price. While asthma patients could purchase generic CFC inhalers for $15 to $25, the HFA devices cost $30 to $60, according to the American Lung Association.
Uninsured patients who pay for medications out of pocket will be hit the hardest, but even asthmatics with insurance will feel a pinch, said Dr. Paul Ogershok, a Waynesburg asthma and allergy specialist. For example, someone who had a $10 co-payment for a generic CFC inhaler might see it rise to $20 for the new HFA product, he said.
“If they have four kids and they’re all on medicines for asthma, that’s $100 a month in co-pays,” he said. “You can see how that can add up, and when you’re dealing in real life with people buying lots of medicines, it’s an issue.”
Pecknyo predicted that the higher cost of the HFAs may affect everyone.
“There are a lot of hidden costs with this, and as consumers we’re all going to pay for that,” he said. “People will say, ‘I don’t have asthma and that doesn’t affect me.’ Well, not directly, but indirectly there’s that trickle-down effect.”
To offset the higher cost, the makers of the four HFA inhalers now available are offering promotions and discounts on their products.
The HFA albuterol products include ProAir HFA, Proventil HFA and Ventolin HFA. Another product, Xopenax HFA, contains levalbuterol, recommended for some patients who don’t tolerate standard albuterol.
Other asthma medications come in dry-powder inhalers, which use no propellants and require the user to forcefully breathe in a very fine powder.
Albuterol inhalers are among the most commonly dispensed items at pharmacies. Although the CFC inhalers still are available, their supplies are dwindling, forcing many patients to make the transition to HFAs well before the deadline at the end of next year.
The HFA inhalers deliver the same medicine and are equally as effective as their CFC counterparts, said Ogershok, who has been prescribing the new devices for more than a year.
“People should be reassured that the products are good and they won’t have any trouble with the switch,” he said.
David O’Neil, pharmacist manager at Fairchance Pharmacy, said he’s delivering the same message to his customers, many of whom weren’t aware of the change to HFAs
“I just tell them that it might taste different and it might feel a little different when you spray it in, but it’s the same drug, so it should provide the same relief,” he said. “I think most people will be satisfied with them.”
As users change to the new inhalers, they must get a new prescription from their doctors.
The transition is creating extra work for some physicians and pharmacists. Doctors must find out which inhalers their patients prefer and, along with the pharmacists, must ascertain which ones insurance plans will cover. The same goes if a doctor prescribes a CFC inhaler and the patient’s pharmacy no longer carries it and must make the switch to an HFA.
“It’s a major headache. You just don’t know which medicine is going to be covered by an insurance company. What’s covered one week isn’t covered the next,” Lizza said. “It’s a lot of phone calls, a lot of follow-up, and then you have to explain to the patients why you’re changing their inhaler. It takes a lot of time.”
Ogershok added, “It takes time from me and time from the pharmacist to make the switch. He’s got a pharmacy full of people, and I’ve got a clinic full of people, and we’re both basically trying to do a simple medicine switch.”
The doctor said he expects his and other physicians’ offices will be busier with asthma patients who need a new prescription for the HFAs, especially people who haven’t seen their doctors for some time.
He recommends that asthma patients be more proactive and take time to learn each insurance plan’s formulary, the list of medications covered.
“If they know that ahead of time before they go see their doctor, it makes the doctor’s job easier,” Ogershok said. “It will mean much fewer phone calls for the doctor’s office and the pharmacist.”