Asthma Sufferers Forced to Give Up Their Inhalers

Published February 1, 2009

Environmental activists have brought an end to the CFC inhaler, a device asthma sufferers have relied on to provide nearly instant relief from the difficulties of breathing.

The new inhalers are more expensive and considerably less effective, critics note.

Effective January 1, 2009, all inhalers sold in the United States must be powered by hydrofluoroalkane, known as HFA. HFA has replaced CFCs, or chlorofluorocarbons, as the chemical used to project the medicine into patients’ lungs.

CFCs have been phased out over concerns they may deplete the Earth’s ozone layer.

Confusion, High Price

For those trying to combat sudden asthma attacks, the switch from CFC to HFA inhalers not only requires getting used to a device that functions differently than its predecessor, it also means digging deeper into the wallet. The new inhalers cost between $30 and $60 apiece, compared with $5 to $10 for the older inhalers.

Asthma patients also will have to adjust to an entirely new sensation when treating an attack. The medicine being puffed into the lungs feels and tastes different than it did when CFCs were in use, and this has unnerved many patients.

“There’s still significant confusion,” said Dr. Harvey Leo of the University of Michigan’s C.S. Mott Children’s Hospital, the Arizona Daily Star reported on December 2. “Patients will tell you, ‘I don’t feel the puff anymore.'”

Unnecessary Burden

Angela Logomasini, director of risk studies at the Washington-based Competitive Enterprise Institute, said moving from CFCs to HFA in inhalers will place a disproportionate burden on those at the bottom of the economic ladder.

“This largely symbolic switch in the name of the environment will have real costs to asthma patients, particularly the poor, who may lack insurance but need access to these life-saving devices. Cost increases could place asthma inhalers out of reach for some, leading to dangerous health consequences,” said Logomasini.

Reduced Effectiveness

“HFA inhalers, like any inhaler, may deliver too little medicine when not used properly,” said Dr. John Dale Dunn, a civilian emergency medicine faculty physician at Carl R. Darnall Army Medical Center. “The new units are more prone to clog, which reduces the spray, and must be rinsed often. They must be primed before use. And the liquid is thinner and runnier.”

Dunn advised attaching a plastic “spacer” chamber to the inhaler to make the new inhalers more effective. With a spacer attachment, said Dunn, “instead of spraying directly into the mouth, the spray forms a cloud in the chamber that the patient can inhale more fully. Studies show 60 percent of a puff reaches the lung with a spacer, and only 40 percent without one.”

Bonner R. Cohen, Ph.D. ([email protected]) is a senior fellow at the National Center for Public Policy Research in Washington, DC.