Asthma treatments must adjust to FDA regulations
Inhalers most widely used by people with asthma are being phased out because they contain a chlorofluorocarbon propellant that cannot be used after Dec. 31, 2008.
However, new products are available that are effective, says Dr. John McDonnell, a Kaneohe allergist/immunologist and clinical professor of medicine at the University of Hawaii John A. Burns School of Medicine.
Costs might be higher because brand-name medications are replacing those in generic form, he said. "But to the credit of insurance companies, they are accepting these inhalers as a midlevel brand" with a co-payment of about $20, he said.
Manufacturers also are giving credit cards for free or discounted inhalers to try to build product loyalty, he said.
Hawaii has about 103,000 residents who suffer from asthma, according to the American Lung Association.
United Healthcare, a UnitedHealthGroup Co., expressed concern that asthma patients might avoid continued treatment because of the higher cost of the new brand-name CFC-free inhalers.
Doctors are recommending that asthma patients begin transitioning to the new CFC-free inhalers.
"Most everybody has no problem with it," McDonnell said.
There are two kinds of inhalers, he explained. The most common one prescribed by doctors, "the immediate reliever," has been a CFC-containing albuterol inhaler that relaxes muscles around the airway, he said.
The second type usually is a powder that is inhaled to stop inflammatory cells that release chemicals that cause mucus, he said. It does not need a propellant.
The Food and Drug Administration banned CFCs, used in refrigerators, air conditioners and aerosols, under an international agreement in 1987. The products did not threaten users' health, but were considered dangerous to Earth's ozone layer, which blocks harmful radiation.
An exemption was allowed for medical products until alternatives were developed.
"The problem arose that the CFCs are so effective as propellants that for years we were afraid that people couldn't learn how to do the other inhaler, and there was no other effective propellant," McDonnell said.
Some people said the argument was "nonsense" that CFCs in the medical devices were adversely affecting the ozone layer, he said, adding it is hard to believe "the little bit of CFC" in the inhalers could threaten the ozone 10 or more miles up.
Nonetheless, he said, Congress removed all CFCs, and two drug companies have made albuterol metered-dose inhalers with a different propellant, hydrofluoroalkane, said to be safe and effective.