Phase-Out Almost Complete
Millions Use Inhalers for Asthma or COPD
The last two inhalers in the United States that contain ozone-damaging chloroflurocarbons (CFCs) will both be taken off the market by the end of this year. People with asthma and chronic obstructive pulmonary disease (COPD) who use these inhalers should talk to their health care providers about a prescription for an alternative.
While change can be unsettling, most people who use inhalers have already switched to those that are CFC-free, and in general, the transition has gone smoothly. The final two inhalers on the market using CFCs are Combivent Inhalation Aerosol and Maxair Autohaler.
Combivent Inhalation Aerosol will no longer be available after July 2013. It
contains two medicines-ipratropium bromide and albuterol sulfate. A
bronchodialator intended to open airways, it is approved for patients with
COPD. An alternative inhaler-Combivent Respimat-contains the same two
medicines but does not contain CFCs. It was approved by the FDA in 2011.
Maxair Autohaler will not be available after Dec. 31, 2013. This inhaler
contains pirbuterol, which is also a bronchodilator and is used for the
treatment of bronchial spasms in patients with asthma or COPD. Alternative
inhalers are available that contain other bronchodilator medicines, such as
albuterol or levalbuterol, but do not use CFCs as a propellant to move the
medicine from the inhaler.
May is Asthma and Allergy Awareness Month5, and thus an appropriate time to
make sure people using these two inhalers know that alternatives should be
considered before the product they are using goes off the market. Sponsored
by the Asthma and Allergy Foundation, this awareness month is also a good
time for people who suffer from those conditions-or who are exposed to
high-risk conditions like cigarette smoke that may trigger the diseases-to
learn about prevention, treatment and resources.
Phase-Out Almost Complete
CFCs damage the ozone, a thin, outer layer in the stratosphere that acts as
Earth’s shield against the sun’s radiation. The U.S. and most other
countries signed an agreement in the 1980s called the Montreal Protocol to
phase out the worldwide production and use of CFCs. In the U.S., CFCs have
been removed from such products as hairsprays, deodorants and air
conditioning.
CFCs have also been used in medical devices, including as propellants to
move medicine out of inhalers so that patients can breathe in the medicine.
For more than two decades, FDA has coordinated the phase-out of CFCs in
inhalers, a process that included input from the public, advisory committees
and stakeholders.
Most inhalers using CFCs have already been phased out. The most widely
used-albuterol CFC inhalers-were phased out in 2008 and replaced with
alternatives that use propellants called hydrofluoroalkanes (HFAs). The most
recent phase-out was of over-the-counter epinephrine inhalers sold under the
brand name Primatene Mist, which were phased out at the end of 2011.
On its website, FDA maintains a list of inhalers for asthma and COPD that do
not use CFCs6, and adds the names of new non-CFC inhalers as they become
available.
Millions Use Inhalers for Asthma or COPD
Inhalers are critical products in helping those who suffer from asthma,
allergies and COPD. In the U.S., more than 25 million people suffer from
asthma, a disease that affects the airways in the lungs and can cause
coughing, trouble breathing, wheezing and tightness or pain in the chest.
Attacks can be mild, moderate, severe and even life-threatening.
Additionally, 15 million people in the U.S .have been diagnosed with COPD, a
serious lung disease that usually causes breathing to get worse over time.
It can limit airflow, and may include chronic bronchitis, emphysema or both.
While all FDA-approved inhalers currently on the market have been shown to
be effective, there are some differences between the products. For example,
products propelled by HFA may taste and feel different than the spray from
CFC-propelled inhalers. Although some consumers note that the spray from an
HFA inhaler feels less forceful, this does not mean that the medicine is not
working. Other alternative medications may use no propellant at all. Your
doctor or healthcare provider can help find the product right for you.
This article appears on FDA’s Consumer Updates page7, which features the
latest on all FDA-regulated products.
