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Next Generation Inhalers: What This Means for You
Paul V. Williams, MD, FAAAAI is a clinical allergist and a member of the
AAAAI Pharmacotherapeutics Committee. Below, Dr. Williams explains the
importance of next generation asthma inhalers.
If you have asthma, you may have heard that the inhaler you are using to treat your asthma may not
be available in the next year or two. This may be concerning to you and, at the
very least, raise several questions such as:
- Why are they doing this?
- Will I have to change medicines?
- Will the medicines be as effective?
- Will it be harder to use the new inhalers?
- Will it cost more?
- Who can I talk to about this change?
Let’s try to answer these questions.
 Background
Several years ago, the United States signed
a treaty with several other countries, agreeing to stop using substances called
CFCs (chlorofluorocarbons) because they add to the destruction of the ozone
layer in the atmosphere, which protects us from the harmful rays of the sun.
CFCs were used in many ways, but primarily as refrigerants in refrigerators and
air conditioners, and as propellants in aerosols. For the last several years,
asthma inhalers have received a medical exemption from the treaty, so you could
still use your inhalers even though they still used CFCs as propellants. Those
exemptions will no longer be granted after 2005, so the FDA and organizations
involved with people with asthma, are trying to set up a gentle transition from
the old inhalers to the new inhalers.
Currently, there aren’t as many medicines available in non-CFC forms, so you may
have to change brands of medicine, but not types of medicine. If you are using
an inhaled steroid, you will still be able to use an inhaled steroid. Your
rescue medicine, which for most people is albuterol, will still be available.
These new inhalers still have to pass the same strict standards that all
medicines have to pass and the FDA makes sure that the drugs are effective and
safe for the treatment of asthma. These medicines, in most cases, will be the
same medicines that are used today for the treatment of asthma; they will just
be using different devices to deliver the medicine to the lungs. There is some
suggestion that the new inhalers may actually be more effective than the old
ones.
Types of New Inhalers
There are two general types of inhalers that will be used in the future. One
type is very similar to the metered-dose inhaler (MDI) that most asthmatics
currently use; it simply uses a different propellant, one called HFA. The new
MDI may have a different taste and less force, but will be used in the same way.
The second type is called a dry powder inhaler (DPI), which does not use a
propellant; rather it comes in powder form that is forcefully inhaled into the
lungs by air. There are actually several DPIs currently in use in the United
States. DPIs are often easier for children to use and have a system to tell the
user when they are empty.
The cost of the medications is the biggest problem right now. Some of the
medicines that will be replaced are now available in generic form, and replacing
them with brand-name drugs will result in higher costs. The FDA, and several
asthma supporting organizations such as the American Academy of Asthma, Allergy
and Immunology, the American Lung Association, Asthma and Allergy Foundation of
America and Allergy & Asthma Network/Mothers of Asthmatics, to name a few, are
working together to try to ensure that these medicines will be available at
costs that aren’t very different than you are paying now.
Hopefully, this article answers some of the questions you might have about the
new inhalers. Your local allergist is
an excellent resource if you have further questions or concerns.
For additional information please check out the following links:
AAAAI Medication Guide
Tips to Remember: Asthma and Allergy
Medications
Allergic Conditions: Medications
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