The New World of HFA Bronchodilators

Okay, December 31^st has passed and reality has set in—no more generic albuterol inhalers are being sold in the United States and it’s time now to switch to an HFA bronchodilator. If you don’t have yours yet, make an appointment with your physician right away to review your asthma management plan and decide which inhaler is best for you. 

HFA inhalers look similar to CFCs, but they are quite different on the inside. Here’s what you need to know: 

HFA MDIs have a softer spray.

The speed at which the medication exits the canister is slower in HFA inhalers, making it easier to inhale the medication correctly. Some patients have commented that the force of the HFA propellant is not strong enough to “push open” their airways during an attack. However, it is the correct inhalation technique, not the force of the propellant, that determines how well the medication works. The force of a CFC or HFA inhaler spray does not “push” or “force” the airways open. 

HFA MDIs have different cleaning requirements.

HFA MDIs need to be cleaned more frequently than CFC MDIs. The HFA medication tends to clog the exit port of the plastic actuator more quickly than CFCs. This prevents medication from reaching patient’s airways, which may explain why patients report HFA inhalers aren’t working. 

HFA MDIs have different priming requirements.

Priming (spraying multiple doses into the air) loads the correct dose of medication inside the inhaler. Each HFA inhaler has different priming instructions – how many sprays are needed and exactly when the medication requires priming – which can be quite different from CFC priming. So be sure to read the instructions carefully. 

HFA MDIs offer more treatment options.

In the past, all brand and generic albuterol CFC MDIswere virtually identical. Now there are three uniquely different formulations of albuterol HFA inhalers plus a levalbuterol HFA inhaler. Although these four MDIs are in the same class of medications—called short-acting bronchodilators—and are used when patients are coughing, wheezing or short of breath, Food and Drug Administration (FDA) officials confirm that each is distinctly different from the others. Some people may find that one HFA inhaler works better for them than another. 

HFA MDIs cost more than generic CFC albuterol MDIs.

HFA MDIs are not simply copies of CFC MDIs with new propellants. The inhaler transition required a complete overhaul of the MDI manufacturing process. Companies had to find a new propellant safe for use in humans, develop new technologies, retool machinery, use new inactive ingredients . . . then test products for safety and efficacy before submitting them to FDA for approval. 
 
 

No generic HFA MDIs are currently available.

This translates to higher out-of-pocket expenses for many patients, even those with prescription drug coverage. Some patients find their insurance plan limits their access to only one brand of HFA. Some patients report the pharmacy dispenses an HFA MDI other than the one the doctor prescribed. 

Pharmaceutical companies are providing financial assistance to patients in the form of rebates, discounts and coupons and patient assistance programs. n 

Reprinted from January 2009 issue of “Helping America Breathe Easier” with permission from the Allergy and Asthma Network Mothers of Asthmatics.