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.
SOURCE: AAAAI - American Academy of Allergy Asthma and Immunology
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