Tuesday, May 13, 2008

Asthma inhalers



The New York Times has an excellent piece today on the phasing out of old asthma inhalers, which has already begun. However, the old asthma inhalers will completely unavailable by the end of the year. Many asthma inhalers are pressurized metered dose inhalers (pMDI's) which means that when you push down on them, the medication sprays out like an aersol spray. Not all inhalers are pMDI's. Some of the newer inhalers are dry powder inhalers (DPI's) where the medicine is not sprayed out, but simply inhaled (Advair and Pulmicort are both DPI's). However, all the rescue medication products available in the US (which is almost always albuterol) are only available in pMDI's. The problem is that the propellant in these sprays was a CFC, which is bad for the enviornment. CFC's have been banned by the government, and the asthma inhalers are the last remaining consumer products to have them. The new pMDI's are made with another propellant, that is more environmentally friendly, HFA. However, there are several differences between the CFC pMDI's and the HFA pMDI's.

There is no generic albuterol HFA
The FDA considers the HFA inhalers new drugs, even though the active ingredient is off patent.
Issue #1- if the physician just writes albuterol, the pharmacist will likely dispense the CFC pMDI which will not be available in January 2009, and more importantly may not be available now because supplies are limited
Issue #2- if the physician writes albuterol HFA, since this product does not exist, the pharmacist will likely substitute one of the 3 branded products (ProAir, Ventolin HFA, and Proventil HFA). However, it may matter to you which one of these you get because.........
Issue #3- each insurance company has a different policy regarding the CFC to HFA transition. The HFA inhalers are much more expensive. On the other hand, insurers worry that increasing the cost of the co-pay may decrease the use by patients and land them in the Emergency Room. Some insurers have picked one of the 3 products and assigned it a generic co-pay while others have no preference and assign all products the same higher co-pay.

There are some differences between the old CFC inhalers and the new HFA inhalers
The spray from the HFA inhalers is weaker. Inhalers require more priming (wasting the first few pumps) before the first use. Patients may feel a difference in the force and taste of the spray ( and confuse this for the medication not working). The HFA inhalers also require a slower and deeper inhalation.

There are some differences between the new inhalers
ProAir, Ventolin HFA, and Proventil HFA are all albuterol products. Ventolin HFA (made by GSK) has one advantage in that it has a dose counter. Research has shown that many asthmatic patients incorrectly estimate how much medication is left in their inhaler. Most inhalers will continue to spray propellant even when the active ingredient has been used up.
Finally, there is a 4th product called Xopenex, which is levalbuterol. The medication is very similar, but because of its structure may have fewer side effects such as shaking or rapid heart beat. Though the branded Xopenex HFA is currently more expensive than the generic albuterol CFC, when compared to the other three albuterol HFA's, Xopenex may be the same or even less of a co-pay then the others, depending on your insurance.

What you should do
1. If you have asthma, disccus the CFC to HFA conversion with your doctor to make sure you are getting the right medication.

2. Know the co-pay level that your insurance will charge you for ProAir, Ventolin HFA, Proventil HFA and Xopenex HFA. If any of these are a generic co-pay, switch now. All things being equal, Ventolin (dose counter) and Xopenex (fewer side effects) may be preferred.

3. Use these medications for rescue only. The medications are really only for bad symptoms and emergencies. Current guidelines state that if you are using these medications more that two times a week, your asthma is not well controlled, and you need a better maintenance inhaler, which is an inhaler you take every day to control your asthma.

4. Recognize the differences between the HFA and CFC inhalers. As above, the spray will feel different, and will require some adjustments (priming, slower inhalations) than your previous albuterol pMDI.

5. Do not use Primatene Mist to save a few bucks. This is an over the counter asthma inhaler. It is dangerous and would never be approved by the FDA today. Older medications that are currently over the counter need to have been proven to kill or severely injure people before they will be pulled from the market. This is hard for Primatene Mist, because hard to say whether or not it was the inhaler or the asthma. The active ingredient is epinephrine which has a lot of side effects.

49 comments:

Asthmagirl said...

Really nice job of explaining the shift on the rescue ihalers. Thanks for making that user friendly!

Amy said...

Thanks for letting me know about this excellent post--especially that last tip. I have to wonder, though--why is the NT Times just now writing about the switch? The American Lung Association has had its PSA up about HFA inhalers for a year now, and I don't know of an asthmatic who can even find the old Warrick ones anymore.

Anyway, love your blog--it's always nice to get a practicing dr.'s perspective on medical news.

Aimee said...

Thanks, Dr. Mintz. I'll be linking to this from the Angry Asthma Mama blog!

RJS said...

In our pharmacies, if a prescriber writes "Albuterol MDI" we will opt for the CFC ALH. When that becomes unavailable, we will switch it over to whichever HFA formulation their insurance prefers.

It's just easier that way. We do have several people that have complained when their provider wrote for an HFA and they didn't like the delivery. They specifically requested a switch back to the CFC formulation, and we've been going out of our way to explain that while they can do that for now, they'll be back to an HFA formulation come 2009.

There are also differences between the various HFA formulations when it comes to priming, shelf-life once opened, and ethanol content. The latter may be of interest for those with specific religious restrictions.

Practically, though, it makes more sense to just write for an albuterol inhaler and leave it wide open so the switchover is as painless as possible unless there is a specific reason that you want a particular HFA brand.

Anonymous said...

I did not realize until reading the NYT article today that CFC inhalers were being banned. I consider myself to be very well informed, but this came as quite a surprise. For what it's worth, in my own personal expereince the new HFA inhalers do not work nearly as well as the CFC models. Until today, I actually thought that my asthma symptoms had worsened over the past year, and I thought it odd that the old, past expiration date inhaler that I keep in my car (probably the worst place to store medicine) was alleviating my symptoms better than brand new inhalers were doing. I now realize why this is happening and that it was not my imagination.

I'm a marathoner. My asthma is well-controlled with inhalers taken preventatively and when mild symptoms strike periodically. I feel like I know what I'm doing with my condition. Honestly, I'm outraged by this ban. It seems a total over-reaction to the harm CFCs can do the atmosphere. The amiunt of CFCs in these inhalers is tiny. I can't help but think that there are going to be a lot of peole with symptoms worse than mine, with more acute problems and less resources who are going to wind up in the E.R. or worse because of this. The average adult with asthma is not getting detailed lectures from a medical professional about a condition that he/she has been controlling well for decades. Sorry, but this is just bad news. At least I know what's going on now.

Eric, AKA The Pragmatic Caregiver said...

The ban also means the near-certain death of Maxair Autohaler, a pirbuterol inhaler with a unique design that delivers the puff at precisely the right stage of the inhalation cycle, without a separate spacer. I've used Maxair for years with great results, and it's very convenient for travel, the gym or outdoor events where it's possible I'll need a puff and don't want to carry extra gear.

Getting rid of the public health exemption for the CFC propellants is going to result in additional deaths from asthma, and that bites.

Christine-Megan said...

Thanks for the post. I just checked the prices on all of them, and Proventil and Xopenex are tier 2 versus the others at tier 3, so I guess I'll be asking for a Xopenex script.

I was wondering about the switch, and have always been curious about Primetine, so it was a great post.

Dr. Matthew Mintz said...

Thanks to all for your comments

Amy, not sure why the piece is appearing now in the NY Times, as this issue has been brewing for some time. My only guess is that as CFC inhaler supplies dwindle, patients are starting to notice the issue.

RJS, thanks for your hard work in trying to educate patients. Our pharmacist have such an important role in patient care (and could do even more if insurers would reimburse for this). Your link to the NEJM table is very helpful.

Anonymous 1:07pm, not sure about the true environmental impact of the CFC's from MDI's. There definitely is a difference as far as force of spray and even onset of action, but theoretically, the inhaler's ability to open up the airways should be about the same.

Eric, in my experience patients put on Maxair love this inhaler, and they are not going to be as happy with the HFA inhalers. I hope you are wrong about worsening asthma exacerbations and even death with the CFC to HFA conversion. If this is the case, it will be less about any potential efficacy difference in the inhalers and more about patient confusion and/or patients stopping necessary medications due to increase cost.

Freadom said...

Excellent post. I might have to link to it from my blog.

Like I told Amy on her blog, I hate the HFA inhalers.

Hey, maybe you have an answer to this q. Why is it that Albuterol can't come out as a DPI?

Just curious. Again great post.

Dr. Matthew Mintz said...

I am not a chemist, but I know there is something about the molecular structure of albuterol that makes it too difficult to be available in an DPI. In Europe, they do make a rescue DPI called terbutaline. It has slightly more side effects than albuterol. Doesn't seem like any US drug company is interested in getting a terbutaline DPI approved in the US.

Eric, AKA The Pragmatic Caregiver said...

I used to use the Bricanyl Turbuhaler (terbutaline) from Canada before Maxair came out; great product - dose counter, no spacer required, reasonably effective.

Sandra said...

Great blog! FDA posted a public health advisory yesterday urging people to transition to the new inhalers and noting the priming and cleaning differences in the HFA inhalers. They said almost a third of CFC albuterol prescriptions had not yet been changed to HFAs. You can read more about it at and find information about patient assistance programs to buy the new HFA inhalers at www.breatherville.org/MDITransition

I also have a comment regarding the word 'rescue'. The new asthma guidelines no longer call these 'rescue medications'. Studies showed that many patients, hearing the word ‘rescue’ thought these medications were only to be used when you’re turning blue. That’s incorrect. These medications are to be used at the first sign of symptoms, before exercise and during an asthma exacerbation. If you need to use these medications more than twice a week, you should talk to your physician about using a long term control medication. An asthma management plan is a big help learning to control your asthma.

Kathi - Asthma Guide said...

Great rundown on all of the issues, Dr. Mintz! In fact, though I've blogged about the CFC to HFA switch many times myself for my readers, I've just blogged again & referred them to this post as you've made some great points anyone can learn from. If anyone is looking for some more concrete tips on getting the most from your new HFA inhaler, you'll find them here:
http://asthma.about.com/b/2008/06/04/tips-to-ease-the-transition-to-your-hfa-albuterol-inhaler.htm

Anonymous said...

Dr. Mintz, what do the patients do that are allergic to corn, ethanol and responded negatively to the Ventolin?

Dr. Matthew Mintz said...

true ethanol allergy is pretty uncommon. most people have ethanol intolerance which is very different. Also, corn allergy (much more common) may have some cross reactivity with ethanol made from corn, but again the reports are pretty rare.
I am not sure if the ethanol in HFA inhalers come from corn. Regardless, the amounts are pretty low. To my knowledge, there have not been reports of patients with corn allergy that have had adverse reactions to the HFA albuterol inhalers. That being said, you should work closely with your doctor when switching to the HFA inhalers if you do have a corn allergy to look out for any problems

PetraFried in the City said...

Dr. Mintz,

A lot of people are having serious problems with the new HFA formulations... You may want to check out this:

http://mayorsam.blogspot.com/2008/06/new-fda-policy-endangers-respiratory.html

Anonymous said...

What effects will the HFA134a albuterol inhalers have on unborn children? Are there any studies to support the safety concerning unborn infants?

Freadom said...

I have an answer to why there is no DPI version of Albuterol. There used to be one, but it was taken off the market. The reason is because asthmatics having an attack were not able to generate enough flow to get the medicine into their lungs.

Hughey Mews said...

I want to ask a question. However, I don't want to scare anyone that has Asthma but need to ask this question. On Feb. 25th 2007 our 26 year old daughter died from an Asthma attack. My husband was able to do CPR and get vitals back. She was life flighted and was placed on life supports for 10 days. The hospital was unable to intubate her until they paralyzed her body. Her lungs were locked down that tight. She had battled Asthma from the time was 3 yrs. old. She was active and played volleyball in high school, on a club level and in college. She snowboarded. So, she was not prone to sitting around. She managed her Asthma well. Her fatal attack happened 12 days after she had to switch to the new mandated inhaler. She had mentioned that she didn't think the inhaler was working as well as her other previous inhalers. She also had a nebulizer that she used for attacks that were not managed by the inhaler. She had many allergies. We have always been suspicious that the inhaler contributed to her fatal attack. An attorney advised us to keep the inhaler for future reference. He is a family friend and had been our daughter's youth group adviser. He had observed her in many physical activities and was familiar with her asthma condition. It did not make sense to him either that 12 days after the switch we ended up with a tragedy. Since the switch to the new propellant was not totally brought about until Jan. 2008 there may be others who will suffer near fatal episodes or the dreaded alternative.

Who is tracking that sort of statistic? Will someone even be willing to track and admit that there is a potential risk?

I hope this has not alarmed anyone but has at least given reason for concern and caution.

Dr. Matthew Mintz said...

Hughley,
I am so sorry to hear about your daughter, and I appreciate you not trying to sound alarmist.
Asthma death, especially so sudden, are quite tricky. They seem somewhat unpredictable. One New Zealand study (in children) showed that asthma severity was not predictive of asthma death. Thusfar, the only thing that seems predictive of asthma death is a family history of asthma death or near death.
I can not think of a reason why the HFA inhalers would cause an asthma death. The albuterol is the same drug, it is just the propellant that is different.
The FDA is supposed to track these, but only if reported. If you have not done so already, you should report this on their web site.
The only thing that comes to mind (and this is speculation, without knowing all the facts) is that one of the complaints with the new inhalers is that the "spray" is not as fast. Patients may feel like they are not getting the drug, when in fact they are. This could theoretically lead to excess use of albuterol, which can cause severe problems.

Hughey Mews said...

Dr. Mintz,
Thank you for your response. I followed the link for mayorsam.blogspot that petrafried posted. The article there led us to an organization in San Francisco that is circulating a petition to save the CFC inhalers. We have contacted them to see what our family can do to assist them. It is important to get someone to listen to others that the HFA inhalers just aren't as helpful. I am amazed at how much information is on the internet about the subject and how many people are being effected. When we started checking for information a year ago there was very little about the subject. I bookmarked your blog a few months ago to watch for helpful info. And, it has been helpful. Our granddaughter is an Asthmatic too. She was exhibiting signs of reactions to the new inhalers which scared our other daughter. She limits her usage and uses the Nebulizer. Our granddaughter is allergic to corn. That information was also a revelation. My daughter will be calling her allergist tomorrow about that topic. So, overall your blog has been very helpful. Also, there is supposedly a pharmacy here in Ohio that still sells the Warwick inhalers. Thank you again.

walker said...

My MaxAir prescription expires this month. Lived with asthma for over 30 years, well-controlled under most circumstances. Told once that pirbuteral was faster-acting but that effects did not last quite as long as other formulations. Prefer faster-acting-when I need it, I really need it to act quickly.

Do any of the new inhalers use pirbuteral instead of albuteral??? If so, I will request my doctor switch me to that one. TIA

Anonymous said...

Warning: Well, this all came as news to me. I have used an Albuterol inhalant for more than 10years on an as needed basis. Suddenly, on January 2,2009, the need arose. I had the prescription phoned in to a local pharmacy (one of the big 3), and when I went to pick it up I was told it would cost $45.99!!! Previously, it was categorized by United Healthcare (Optimum Choice) as a Tier 1 Rx, for which I pay only $10 as the co-pay. Now, with no prior notice they changed it to a Tier 3 (up to a $50 co-pay). I really wonder about this since it ended up costing 4-1/2 times what it used to cost with the CFC propellant.

Dr. Matthew Mintz said...

Anonymous United Healthcare (Optimum Choice) paitient,
Please check with your insurance regarding their preferred albuterol HFA MDI. According to what I found on the web, for United/MDIPA's 2009 Formulary Xopenex HFA is a tier 1 product, and thus should cost no more than you were paying before the switch. Xopenex is also my preferred HFA because it has fewer side effects then albuterol.
Also, note that though your pharmacy has access to this information, they may not tell you, since the drug companies give them incentives for certain products. If your doctor writes a prescription for generic albuterol, many are switching to the albuterol HFA product (Ventolin, Proair, Proventil) for which they make the most money. Finally, theoretically all inhalers, but definitely xopenex because it is a different molecule will require a new prescription.
If you have not opened the inhaler you were given, I would ask your doctor to write a prescription for xopenex HFA and return the expensive inhaler you were given.

Eric, AKA The Pragmatic Caregiver said...

I, too, was shocked to find Xopenex in Tier 1 in my plan (managed by MedImpact). Pre-HFA ban, it was among the most expensive Tier 3 options.

Dr. Matthew Mintz said...

Unfortunately, it's a numbers game. The makers of Xopenex HFA (Sepracor) were able to negotiate a much better deal with United then the makers of the other 3 inhalers. The problem is that is hard for both patients and physicians to know which agent is the preferred/cheaper one. In addition, these often change and usually without notice.

Ray from Texas said...

The new Albuterol inhalers with HFA propellents are not as effective. I have had asthma over 20 years. My asthma was mostly controlled by using CFC Albuterol inhalers in combination with Flovent. Since the CFC inhalers were banned, my asthma has gotten much worse, even though I take many more puffs of HFA inhalers per day. Since Albuterol is a very fast-acting drug, it is easy to test it, and, almost immediately, an asthmatic person can tell if it helped or how effective it was. I wonder how HFA was tested. I can see FDA people and so called environmentalists, probably with encourangement from already too fat pharmaceutical companies, went ahead with this approval. Why the doctors and other health professionals who work with the patients every day and can see their suffering, went ahead and approved this expensive and ineffective new propellent is baffling.

Anonymous said...

I know for a fact that QVAR (who also makes brand of albuterol) uses ethanol derived from Corn. Med desk tried to say it "may" be from sugar. Finally Pharmacist for Qvar knowing I was severely ill and had corn allergy said "not an option for your patient." My doctor thought I had Lupus, spent lots of $$ for blood work. Switched from advair in attempt to save $$ as my drug program was minimal for Advair). I am highly allergic to corn. My doctor and local pharmacy was unaware that the albutelol and Qvar used ethanol. Tired of the argument that product is the same and it's all in my head. Though back on Advair and Singulair the Ventolin when needed, seems to not only not work as well, but even without ethanol I am breathing worse after using it. If I don't use it then I'm better until I have an immediate situation where I try again.

Anonymous said...

The fact of the matter is that the new CFC-Free inhalers *do not* work well at all. I think this is a travesty to those who have asthma, and they should bring the CFC Albuterol back for us. This is a cruel joke.

Anonymous said...

I got my first HFA inhaler in August and have had a severe itch ever since and my breathing has gotten worse.I have had blood test all are good. I went to a allergy specialist,Dermatologist even a chiropractor.No one can tell me why I am itching. I think it is the new revised inhaler.

Dr. Matthew Mintz said...

Anonymous 2/13,
Without more details it is hard for me to give specific medical advice.
Any drug can have any reaction in any patient. If my patients tell me they think that a medication is causing a side effect, I may explain that I think this is unlikely, but never discount the possibility.
HFA inhalers should not make you itch or make your breating worse, BUT I would not discount this.

Please ask your physician about the possibility of stopping your HFA inhaler. If your asthma is under control, then you really shouldn't need an albuterol HFA inhaler, except infrequently.
If your asthma is not under control, then you should ask you doctor about stepping up therapy so that it gets under control.
For example, if you are taking Singulair or Asmanex daily and needing the albuterol HFA a few times a week, you could switch to Advair (non-HFA). This would control your asthma better, and allow you to stop the HFA albuterol to see if the itching goes away. If it does, you can re-try the albuterol HFA and see if it returns. If it does, then the albuterol HFA is likely causing the itching.

Brian said...

I've been on inhalers 5+ years. I also have the side effects (noted and explained by Dr's) of the rapid heart beat and shaking. I just saw the Grey's anatomy and was ?? on new inhaler?. Sure enough the one I got from the VA this week is the HFA Proventil. No wonder it didn't seem to work well. Not only for breathing, but I didn't get the side effects. Makes me think the effective delivered dosage of albuterol is decreased or...??? They must bring back the CFC ones.

Anonymous said...

I am so sick and tired of doctors saying that the HFA inhalers work as well as the old ones. It's bullshit. yeah, some people can tolerate them, but how do you explain all of the people who can't? are they all making up stories? are they all crazy? liars?

give me a break! Pro-air is the WORST of them all. I have had asthma under control my whole life. Now that I had to switch to the HFA's- it is out of control and there's not a damn thing I can do about it.

Don't come to any of these blogs seeking advice is the HFA is not working for you, because none of these doctors are going to help you. They all INSIST that the new inhalers work as well as the old ones.

People are going to die from their asthma because they cannot get relief from the HFA's. Plain and simple. My pharmacist has told me he has had over a thousand complaints about them, and fears for everyone's safety, but the FDA, The Asthma and Allergy Association and most doctors don't seem to give a shit about all of us who are suffering.

I really hope this petition works, because it will save lives. It's honestly your only hope if you can't tolerate the new inhalers.

Arthur Abramson said...

"I can not think of a reason why the HFA inhalers would cause an asthma death. The albuterol is the same drug, it is just the propellant that is different."

Perhaps I can help.

1) Ethanol in MDIs is a PROVEN BRONCHOCONSTRICTOR for some asthma patients. We link to the medical letter that proves this on the 'Press Room' page of our website at www.saveCFCinhalers.org We also link to a medical paper that uses an animal model to explain how this works.

2) The HFA-134a propellant was NEVER tested on asthmatics or other pulmonary patients- it was only tested on normal, healthy volunteers. Normal healthy volunteers tend not to have hyper-reactive airways, severe allergies, or inflamed lungs, etc.

3. The HFA MDIs have a whole new witch's brew of unique extractables and leachables that are potentially very dangerous. You may read about this on the page of our site titled 'HFA MDIs: Poorly Tested'. There are many OTHER potentially dangerous impurities in HFA MDIs besides extractables and leachables.

4. Technical staff at Sepracor (Xopenex HFA) and Schering Plough (Proventil HFA) have told us that the corn residue in the corn-sourced ethanol (yes, it's all corn-sourced) may indeed be a separate risk for corn allergic patients.

5. Schering-Plough says of Proventil HFA (we have the link in the 'Press Room'): "RAPID HEART BEAT, VOMITING, CHEST PAIN and PALPITATION OCCURS MORE FREQUENTLY WITH PROVENTIL HFA (than with CFC albuterol)." WHY IS THAT? Clearly, these products are NOT equal in safety.

6. If you look at the side effects comparisons in the Ventolin HFA and Proventolin HFA clinical trials (links are in the 'Press Room') a bright 10 year old can figure out in 60 seconds that the Albuterol CFC is MUCH SAFER than HFA formulations.

7. If you look at the UK postmarketing study on the 'Press Room' page, clearly CFC does MUCH better.

8. If you look at the New Zealand study: DITTO.

9 If you look at the HFA vs CFC summary chart of three years of FDA MEDWATCH DATA halfway down the same page- DOUBLE DITTO.

10. In conclusion, it's NOT the ACTIVE ingredients in HFA MDIs that are the problem- it's the INACTIVE ingredients (excipients, such as ethanol and HFA-134a) and the IMPURITIES that are the problem.

For some reasons, many doctors seem to labor under the delusion that inactive ingredients and impurities in HFA MDIs are harmless. I don't know why. This is the biggest mystery of all.

Arthur Abramson
The National Campaign to Save CFC Asthma Inhalers
www.saveCFCinhalers.org

candy t said...

ProAir HFA put me in the hospital with severe broncospasm.

Hughey Mews said...

As I continue to watch the growing number of people that are having severe reactions to the new inhalers; it is a mystery to me why the medical community doesn't get it that these inhalers are dangerous.

Krimson's mom

Cheetahlynns said...

I recently had to start using the ProAir HFA inhaler in Feb'09. The long and not so sweet of my angst over this inhaler goes as follows:

I started coughing back on 02-24-09. I coughed so hard my throat was raw the next day. Coughing makes me asthmatic - its my sign that I am having an asthma attack so I used the new ProAir Inhaler. Funny, but after 2 puffs, I was coughing more. 2 more puffs and I was still coughing. I noticed right after I opened the ProAir that it smelled funny, noxious almost. I had some left over narcotic cough syrup and had to use that to get the coughing somewhat calmed down. I finally went to the doctor because my throat hurt so bad I could barely swallow, I had lost my voice, and I was coughing a lot. Had a fever as well. I saw the dr 5 or so days after I started in with these symptoms and was prescribed antibiotics. 10 day supply. Well, one month later it started again. I had a large amount of trouble getting my coughing under control. I also had trouble with a continously scratchly/irritated throat which made me cough. Anyways, almost like daja vue, it all started again. Used the ProAir HFA again and boy did I have a sore throat. It was extremely painful. I could barely speak my voice was so raw and just gone. I really tried to do the good old deny deny deny - its just a sinus infection but after 10 days, I wasn't getting better and finally gave in and went back to the doctors. I finished that prescription back on April 19th. On April 24th, I started coughing again. I don't have my tonsils - they were removed back in 2002 so I knew they couldn't be the problem. I haven't had asthma this bad - EVER. I was scared. I didn't know what was wrong with me. I used that awful inhaler in good faith - thinking it was helping me. 4 puffs later, I was still coughing that Friday. I had to use cough drops, narcotic cough syrup and liguid caramel to sooth the good awful ache in the back of my throat. It hurt so bad on the right side, I was thinking - thyroid, cancer, I don't know what but I was scared and didn't know what was wrong with me. The only thing that I was inhaling was the inhaler. But you can't be allergic to your inhaler, I thought. Well, it did smell funny so I looked online for side effects and OH MY GOSH! All these complaints. 14% of users get sore throats. Ethanol is a known cancer agent. Allergies to the inactive ingredients rampent. I wasn't dying. I wasn't having throat cancer. I wasn't sick from a flu or sinus infection but from my inhaler. IT IS AN IRRITANT!!!! If it irritates my throat and makes me cough, how in the hell is it supposed to help my asthma?!!! I only have exercise induced asthma. I have never had this many problems. I only used the inhaler because I was coughing and couldn't stop and thought it would help me. Nothing tells me very much what an allergic response to Ethonal is only that Ethanol is a cancer agent. I found that 14% of users have sore throats and all the complaints were enough to help me realize that my inhaler was slowly killing me. If I slowly am losing my ability to breath, then I am slowly being killed and that is what that inhaler was doing to me. I threw it out. I used my old CFC Albuterol inhaler and after 2 puffs my coughing abated. The next day my sore throat was marginally less sore. I understand not every one responds the sameto the HFA inhalers. The people trying to save the CFC inhalers make a good point about the test subjects that were used for the HFA inhaler test were healthy compared to the regular users of an inhaler. IF they'ver never had allergies and never had asthma, how can that be a valid test? If the product makes the symptoms worse - whether its being covered by doublespeak and that is what the FDA is feeding us - that the ProAir is just as effective - maybe the chemical is but not the product packaged to deliver the chemical -if the product package is a threat to those trying to receive asthma relief than it is ineffectual. Why risk lifes? Why not give us a choice? Most people who have asthma have allergies. Obviously however packaged the CFC inhalers were, they did not cause reactions like these. My asthma did NOT get worse with the CFC inhaler. My throat was NOT turned to so much raw meat with the CFC inhaler. How many deaths will it take for the blinders to come off and someone hear us? What permanent damage has been to my throat because the FDA continues to mis-lead the public by toting that the active ingredients are just as effective in the HFA inhaler as in the CFC inhaler - all the while ignoring those suffering from the inactive ingredients.

I know this is long but as I sit here, my throat stills aches and I am scared what I will do if I have another asthma attack. I don't ever want to touch another HFA inhaler again. The pain was horrible and still bothers me on a lesser scale. We should be given a choice.

How many others out there have suffered from a sore throat and been depleted to almost no energy after fighting these "side effects"? I'd really like to know....Lori

Hughey Mews said...

Hi Lori,
You are not the only person experiencing these side effects. Our daughter, Krimson, most likely died from the Proventil Inhaler side effects. I am going to give you two links to go to for support and additional information.

https://www.savecfcinhalers.org/

http://www.journalgazette.net/apps/pbcs.dll/article?AID=/20090329/BIZ/303299878/-1/BIZ09&template=printart

Our granddaughter who also is an asthmatic experiences side effects from the Pro-Air inhalers. She is presently taking Xopenex. It is working well for her at the moment.

I am so sorry you are experiencing such severe reactions. It is not fair that you have to suffer like this. Please check out savecfcinhalers.org site. They are trying to get someone who cares to listen to the multitudes that are suffering from these new HFA inhalers

Maureen

Anonymous said...

I have anaphylactic reactions to all corn products. I can't even go to the movies. You may not get it what the difference is until you experience it.!!!! I will tell you first hand that I wouldn't wish it on my worst enemy!!!!

Anonymous said...

As a busy mom I missed the changeover to HFA inhalers. I wanted to share the story of my son has been using Flovent for years and started having random allergic reactions we couldn't figure out.

He was also complaining that his inhaler was making him feel worse and kept grabbing for his albuterol inhaler right after.

After we used up our supply of flovent from our house, the one at school and grandma's house he flat out refused to take it.

So I went online thinking maybe there was a recall-that's how I found out about the corn based propellent. My corn allergic son had been inhaling corn. No wonder there was a reaction!

How's that for a blind test?

We've switched to the diskus but are searching for an answer for an albuterol inhaler. Meanwhile Dr. suggested a hand held nebulizer. OK for now, but that sure isn't going to last during his teen years now is it?

Good luck everyone. I hope we can get the old inhalers back.

Dr. Matthew Mintz said...

you are not the only person reporting allegic reactions to the corn based component. You are also correct that a hand help nebulizer is not the most ideal solution. One thing to consider is the frequency of the need for albuterol. If it is more than once a week, you might want to consider Advair which combines the fluticasone with salmeterol. The discus does not have the corn based propellant, and if he is using albuterol once a week, though by definition not poorly controlled asthma, may benefit from both the regular use of combination medicine and more importantly, decrease need for an handheld nebulizer.

Sara said...

It seems very odd to me that you can state that the minute amount of corn should not pose a problem for corn-allergic HFA users. An individual with peanut allergies, let's say, can inhale a minute particle, not even touching the peanut, and have a severe anaphylactic reaction, yet you don't feel that inhaling directly minute particles of a substance one is allergic to could cause a reaction? I just don't understand the logic. I'm sure for years Doctors didn't realize the dangers of or the causes of allergies to other allergens as well. If someone walks into my home and I have cats, they can immediately begin with allergies and asthma without coming into direct contact with the cat. The same thought process follows to include other situations such as with seasonal allergies. I would ask that you please reconsider your statement that the corn ethanol is present in the inhaler in such a small amount that it shouldn't be a problem. You really sound ill-informed and an uneducated Dr.

M Witcher said...

If you haven't taken the time to research who you're taking advice from, let me share a few things about Dr. Mintz with the rest of you here:

Dr. Mintz is NOT an unbiaased professional physician and he is NOT your doctor. Dr. Mintz sits on the Advisory Board of GlaxoSmithKline, the pharmaceutical giant that manufactures Ventolin HFA and ProAir HFA (the products that replaced everyones albuterol inhalers after they were banned).

Dr. Mintz is paid hundreds of thousands of dollars each year to sit on GSK's Advisory Board and to speak at conferences on behalf of GSKs drugs. Is this someone who can give you fair and honest advice about the efficacy of HFA inhalers?

The truth is that while asthmatic and COPD rescue medication, containing CFCs, was banned by a U.N. Treaty, which was signed into law by Congress, hairsprays sold everywhere still contain CFCs.

I have spoken with patients, doctors, and pharmacists around the Country and I have yet to find anyone who believes that HFA inhalers have the same efficacy as CFC inhalers; not even close. One of the main reasons for this is that albuterol is most effective when it is inhaled deep inside the lungs. The HFA propellent does not allow this.

So why is our rescue medication (which is inhaled into our lungs)banned, while hairspray that contains CFCs as their primary ingredient, are still sold freely? Welcome to legislative fraud. This is whst happens when a bunch of environmentalists join with pharmaceutical giants to ban an environmental danger, replacing generic medications in the marketplace with name brand HFA albuterol inhalers. The pharmaceutical companies make a massive fortune AGAIN, and patients suffer.

Yes, Dr. Mintz, "Really nice job of explaining the shift on the rescue inhalers." Why don't you explain how much CFCs are released annually by asthma rescue inhalers versus hairsprays?

Anonymous said...

Reference to: Posted by Dr. Matthew Mintz about Primatene Mist.

Have COPD and was taking inhalers along with Alberteral liquid for 8 years. It really didn't cost that much but wasn't satisfied with results. It seemed I always had to be restricted to the machine. I ALSO HAD ABOUT 20 PANIC ATTACKS A MONTH BECAUSE MY MIND THOUGHT I WAS SUFICATING.
I than tried the Primatene Mist and used it for now on 8 years. It seems funny I don't need the others at all and haven’t used the liquid in months. I only use one inhaler of Primatene mist every month. Feel ALOT better and it also reduced my panic attacks by 98%. Conspiracy I would say for it to be removed by FDA and the drug companies to remove from market. They tried to get it off a few years back. Everyone I know with the same problem swear by the product. Also, the price was lower than the prescription ones. How come there selling on Ebay for 75.00 to 150.00 each now and they are selling? I paid this amount because they WORK not because they our cheaper.
Maybe you should put a plastic bag on your head with rubber band and see what it feels like not to get air. If you would like I can help you with that experiment. Than you will know what it’s like to suffocate? When you pass out I’ll remove it for you. You may loose a few brain cells but it seems you lost a lot already.

Anonymous said...

you know when the new docotrs comes out with these ridculous medicines like ventolin hfa .. I want to sue the doctors and the people there like primtine mist .i have used the primitne mist for ages and ages. now the us govt is telling me and others to screw off ()especilly the witch doc that was in urgent care right now im using pri mist tabs for my broco spasm there i think this a joke on the us people like myself .. i could go back again for the er doc the at the hospital there at memorial every day i count down to see if i can breathe at night. the doc wouldnt even blink an eye for me to get broncometer for me to me it a circus mentality between the doctors and the pharmacuticals fighting against me and others for little sprayer that does great thing shame and shame on those doctors they should have their credentials taken away for a b.s deal on the ozone layer .thanks george

Anonymous said...

Well I feel that taking a way an over the counter inhaler is hurting the people that either don't have or can't afford health insurance. I've searched high and low for inhalers to help my husband and people are selling the mist for 300.00 and other inahlers for 100 and more. We sell over the count drugs for allergies, achs and pains, cold medicine,etc. No matter what a person takes can be harmful to them, children are now drinking hand sanitizer to get drunk, so does that mean we take it off the market because children are becoming ill? People have over doesed on advil and so on, does this mean we take it off the shelves absoutly not. We are already hurting the enviroment with cars, and business who allow the chemicals to fill our air, careless people throw trash where ever they want. So taking away one inhaler from people that have medical bills that are 1,000 of dollers because they have an asthma attack and coffee, or sitting in a steamed bathroom isn't working. So really then does it matter if an inhaler is this that or the other thing, in the future i guarantee they'll find something wrong with it any way.

Anonymous said...

As far as I'm concerned, the FDA are murderers. Since this piece of crap ban I have been unable to work. I lay in my room waiting for the inevitable. There are no free clinics were I live and I will be damned if I will go to the emergency room paying thousands for something I could handle over the counter before. I pray to God every one of these people who supported this ban and voted for it are killed in a horrible fashion or die of some horrible disease that gives them the greatest amount of pain possible. I mean that with all my heart. If I had a gun and the energy to use it, I would hunt the FDA council who voted for this down and kill them ALL!

margaret savannah said...

Dr.Mintz,In answer to youre comment concerning Primatene Mist,and the advice not to use it.I so totally disagree.I have been using this medication since I was 20 yrs old,I am now sixty five.My M.D.became concerned with the amount of prescription inhalers I was going through,he suggested I try Primatene Mist.My asthma at that time was a constant problem for me.After I switched to Primatene Mist I have had no issues,My blood pressure is normal and my health in general is great.I recently had to switch to a prescription inhaler which was totally ineffective.I now use a nebuliser over the counter asthma medication with absolutely no problem.I find youre reasoning that there is no way to track deaths that may have been caused by Primatene Mist ludicrous as Im sure the medical professional who would be in charge of such a case would be aware of the use of such a drug.

Dr. Matthew Mintz said...

Maraget,
I am glad you are doing well on Primatene Mist. However, most patients with chronic asthma do not do well on either albuterol or Primatene mist alone. Use of any beta agonists more than twice a week is 1) associated with bad outcomes like ER visits, hospitalizations and even death and 2) all national and international guidelines suggest that these patients should be on an inhaled steroid.
My concern with Primatene mist is two fold. First, prescription albuterol is at least as effective with fewer side effects. That being said, if some people respond better to Primatene then albuterol, then they should be able to take it. However, I believe this should be under a physician's supervision and thus available by prescription only. Second, patients using just Primatene OTC likely have not seen a physician for their asthma and are at risk for bad things happening. Thus, in your case, where your physician recommended Primatene, and it worked, that's great. However, this is a not what commonly happens.