The new year has rung in a new era of green and efficient asthma inhalers, but some lung patients are mourning the end of the low-cost, trusty puffers they have used for years.
Since Jan. 1, federal health officials have banned emergency-use inhalers with chlorofluorocarbon (CFC) propellant that harm the Earth's ozone layer, raising the risk of skin damage and global warming. In their place come inhalers using ozone-friendlier hydrofluoroalkane (HFA).
Lung experts call the new inhalers superior, delivering an identical dose of albuterol medicine in a finer mist that can penetrate deeper into the lungs to better ease the inflammation and mucus in an asthma attack.
"It's a better product in many ways," said Dr. Morton Schwartzman, a lung specialist at Memorial Regional Hospital in Hollywood. "My patients have shown no resistance. They're getting used to it."
Not Leonard Eisenberg. Like some lung patients nationally, the Boca Raton, Florida, asthmatic, 78, complains the new inhalers don't relieve symptoms fully and that the price is much higher. He gave up on the new models and now buys old ones online from overseas.
"It doesn't work very well," Eisenberg said. "It's a very weak spray. I got my two tubes [400 puffs] for November, and they were gone way before the end of the month."
Health officials said they hope asthmatics do not cut back, risking more attacks and complications, because of the cost or dissatisfaction with the new devices.
The inhaler changeover has been an issue for 20 million nationally since it was announced in 2005. Federal officials said more than two-thirds have switched, but doctors said holdouts include chronic lung patients and seniors who rely heavily on the puffers.
Asthmatics use albuterol inhalers in emergencies to open their clogged airways during acute attacks of breathlessness. Ideally, longer-acting drugs control the disease so patients need inhalers only once a day or so. But those with chronic lung problems often need a puff every few hours.
The old CFC inhalers have worked well for decades, and because they sell as generic drugs, patients usually get them for free or a $5 co-payment.
The Food and Drug Administration banned CFC inhalers after the United States signed an international treaty to remove it from most products.
The new HFA inhalers relieved patients equally well in studies and are well-accepted since coming out in 1996, said Dr. Norman Edelman, medical officer of the American Lung Association.
But some asthma patients say the new puffers do not fully halt asthma attacks, sending a few of them to emergency rooms. Lung experts said the problem most likely is one of perception or incorrect usage.
The new units have a lighter heft and a softer spray that may not feel satisfactory to a panicky asthmatic struggling for breath, said Andrew Cuddihy, lung association program director in South Florida.
"They don't get that visceral feeling, 'I just got my medicine and now I'll feel better,'" said Cuddihy, who uses and likes the new inhalers.
He and other experts agreed that if not used correctly, HFA inhalers may deliver too little medicine. 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.
One solution: Attaching a plastic "spacer" chamber to the inhaler. Instead of spraying directly into the mouth, the spray forms a cloud in the chamber that the patient can inhale more fully. Schwartzman said studies show 60 percent of a puff reaches the lung with a spacer, 40 percent without one.
But "the biggest problem for HFA" is the cost, Schwartzman said.
Eisenberg said his HMO charged no co-pay for generic CFC inhalers, but the new ones cost him $60 a month.
FDA officials said even though new units contain the same drug, they are considered brand-name drugs with higher cost because the formula was tweaked to work with HFA. So far, no generic has been proposed.
"People should complain to the insurance company," said Dr. Amjad Munim, an asthma specialist at Holy Cross Hospital in Fort Lauderdale, Florida. "These insurers should make an exception and not have any co-pay."
Bob LaMendola can be reached at blamendola@SunSentinel. com or 954-356-4526 or 561-243-6600, ext. 4526.