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HFA Asthma Inhalers: Making the Switch

Deadline to make the transition to HFA inhalers is fast approaching. WebMD explains how HFA inhalers differ from CFC inhalers and how to make the changeover easier.

1. What are the differences between CFC and HFA inhalers? continued...

"The feel is a little different, so if somebody is switching, if they're not aware that the HFA jet is more gentle, they might feel they're not getting the same amount. It's just as effective, but people's expectations need to match what they're receiving," says Martha White, MD, an allergist in Wheaton, Md.

Three of four inhalers available - Proventil HFA, ProAir HFA, and Ventolin HFA - dispense albuterol. The fourth HFA inhaler, Xopenex, carries levalbuterol -- another bronchodilator agent of the same class as albuterol. White says her patients on the Xopenex report that it feels "cleaner."

The HFA propellant also is "gummier" than the CFC propellant, so it's important to clean the plastic sleeve that holds the canister, ideally after each use, but at least once a week. Users may also notice a difference in taste.

HFA inhalers also need to be primed, or sprayed a few times in the air before using, according to guidelines from the American Academy of Allergy Asthma & Immunology.

2. Is one HFA inhaler more effective than another?

No. In studies with children and adults, the effects of HFA albuterol on lung function tests have been shown to be similar to CFC albuterol. With Xopenex HFA, some people get less jittery than with other albuterol inhalers, White tells WebMD. Ventolin HFA has a dose counter so you know how many doses are left, whereas Proventil HFA and ProAir HFA do not have dose counters.

3. So what's the major difference between CFC and HFA inhalers?

Cost.

CFC inhalers run about $5-$25 apiece, whereas the HFA inhalers cost $30 to $60, according to the American Academy of Allergy Asthma & Immunology.

The HFA inhalers that have been available for about two years are brand-name, and it could be five years before patents expire, allowing less expensive generics to enter the market.

Sandra Fusco-Walker, director of patient advocacy for the Allergy and Asthma Network Mothers of Asthmatics, points out that the cost can be especially burdensome if parents need to buy inhalers their children can keep at home and in school. AANMA is part of a MDI (metered dose inhaler) working group that went to Congress last spring to ask lawmakers to consider subsidizing the cost of the HFA inhalers, to no avail.

"People are having to make a choice between a bronchodilator and controller medications, but we need these bronchodilators on us if we have symptoms," Fusco-Walker tells WebMD.

The drug companies that make the four HFA inhalers offer assistance programs to patients who cannot afford them. For information, call the Partnership for Prescription Assistance at 1-888-477-2669 or visit the web site at www.pparx.org.

4. How many quick-relief inhalers do people with asthma need in the course of a year?

Norman Edelman, MD, a pulmonologist and chief medical officer of the American Lung Association, says two to three inhalers should be enough to last a year. Canisters contain somewhere between 180 and 200 "puffs."

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