So Long, 2008—and Farewell, Cheap Asthma Inhalers

The last day of 2008 means more than the dawn of a new year for asthmatics. For those told to carry albuterol inhalers with them to use in the event of an asthma attack, it's also the last day that the chlorofluorocarbon, or CFC, inhalers that they'd long been accustomed to can legally be sold in the United States. CFCs are harmful to the environment, so they are being replaced in inhalers with environmentally friendlier hydrofluoroalkane, or HFA. Unfortunately, the new, eco-sensitive inhalers are not yet available in generic form.

I made the trip to my pharmacy about two weeks ago to pick up my prescription for HFA albuterol inhalers. Like other asthmatics, I was dismayed by the cost: a $30 copay for two inhalers under my insurance (which paid $43.72 toward the cost). In the past, my copay had been just $10 for each pair of generic albuterol inhalers containing CFCs. The Food and Drug Administration has approved the following HFA inhalers: ProAir HFA Inhalation Aerosol, Proventil HFA Inhalation Aerosol, and Ventolin HFA Inhalation Aerosol; also, another HFA inhaler that contains levalbuterol, a medication similar to albuterol, is sold as Xopenex HFA Inhalation Aerosol.

But I'll have a cheaper alternative the next time I need a refill. Wal-Mart announced yesterday that it will sell an approved HFA inhaler, made exclusively for Wal-Mart by ReliOn, starting at $9 apiece. That's good news for asthmatics for whom cost is a barrier to picking up the new inhalers.

Robert Fisher, a Wisconsin allergist and a fellow of the American Academy of Allergy, Asthma and Immunology, says that his patients have expressed concerns about paying for the more expensive HFA inhalers out of pocket. And even patients like me who have insurance coverage are liable to pay more, because the copays for brand-name medications tend to be higher than generic copays.

The new HFA inhalers also deliver a softer spray, which has some patients complaining to their doctors that they don't feel that the meds work as well as CFC inhalers. The spray from HFA inhalers "doesn't come out as cold or as forcefully," Fisher says. Still, he says, "the active ingredient is the same."

In fact, studies show that the newer inhalers are just as effective as the old ones, says my allergist, Bruce Bochner, director of the division of allergy and clinical immunology at the Johns Hopkins University School of Medicine and an AAAAI fellow. "These new products are delivering as much albuterol as the old ones," he says. "They may taste or feel different, but it should work as well."

If you still have older CFC albuterol inhalers in your purse, pocket, or medicine cabinet, feel free to use them up. Just check the expiration date, experts advise; many people carry inhalers around for months or years. If they've expired, it's time to call your doctor for a prescription for an HFA inhaler, says David Shulan, a New York allergist and an AAAAI fellow. Whatever you do, don't stop using your inhaler (I regret making that mistake) without talking to your doctor first.

So far, asthmatics seem to be adjusting well to the change. "We started switching people over a year ago," Shulan says. "In the past year, I've had maybe one complaint. The vast majority of people really have not complained about problems with the switchover."

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