Asthma sufferers must go "green" on inhalers this week

ST. LOUIS — With 2008 drawing close, people with asthma and other respiratory ailments only have a few days before the last of the inhalers that use ozone-depleting chemical disappear from pharmacy shelves and are replaced with new "green" devices.

Because the new devices are more expensive, the switch has raised the possibility of last-minute hoarding. It also has triggered concerns that the added expense of the new inhalers — which could cost an extra $25 a device — may lead low-income patients to cut back on purchasing needed prescriptions.

"It's possible people may skimp on their medicine because of the cost," said Dr. Bradley Becker, co-director of the Asthma Center for Children at Cardinal Glennon Children's Medical Center.

Many doctors have been prescribing the new inhalers for several months, helping patients transition to the devices, which use the more environmentally friendly propellant hydrofluoroalkane (HFA) and deliver the quick-relief drug albuterol.

Some physicians and pharmacists, however, said they wouldn't be surprised to see patients rush to grab the old inhalers, which use harmful chlorofluorocarbon as a propellant. The last day for the old inhalers to be sold is Wednesday.

The new HFA inhalers can cost as much as five times the price of the old ones. That's because there is no generic version available.

Most HFA inhalers cost between $30 and $60, whereas the old inhalers are priced between $5 and $25, public-health groups report.

The American Lung Association estimated more than 20 million people in the United States have asthma.

The old inhalers are being phased out as a result of the U.S. participation in the 1987 Montreal Protocol, an international treaty to ban substances damaging the Earth's ozone layer. After the agreement was signed, drug manufacturers were given an extension to develop "green" inhalers.

The U.S. Food and Drug Administration (FDA) has approved three albuterol inhalers that use the HFA propellant: Ventolin, Proventil and ProAir.

Albuterol inhalers are frequently used to help relieve asthma but are also used by people with emphysema, chronic bronchitis and chronic obstructive pulmonary disorder. Albuterol provides relief by opening the airways in the lungs, but it does not prevent asthma attacks.

In general, the new inhalers deliver the medication with a softer puff than the old ones. That led to some confusion about the devices' effectiveness, doctors said.

"Many say that they feel like the inhaler isn't delivering the medicine," said Dr. Mario Castro, a pulmonologist and associate professor of medicine for Washington University's School of Medicine.

The FDA said new inhalers work just as well as the old ones when used correctly.

Among the differences facing patients: the new inhalers must be primed more often than the old CFC inhalers and they must be cleaned more frequently because they tend to get clogged.