Asthma inhalers that contain the medication albuterol to relax the airways also contain chemicals that harm the ozone layer, so US health officials are taking them off the market.
Starting in 2009 new products will have replaced these inhalers completely.
Physicians are urging patients to switch to alternative inhalers now.
Chlorofluorocarbons, or CFCs, are widely used to propel inhaled medications into the lungs.
However, products containing CFCs are being phased out, because the chemicals damage the earth's protective ozone layer.
CFC inhalers are being replaced by inhalers powered by HFAs, or hydrofluoroalkanes, which are ozone-friendly.
The change to HFA-powered inhalers has been in the works for several years, but the US Food and Drug Administration (FDA) issued an advisory urging patients still using CFC inhalers to switch now. FDA officials say persons may need some time to acclimate to HFA-based inhalers.
"There are 52 million prescriptions written for albuterol inhalers each year in the United States," says Dr. Badrul Chowdhury, director of the FDA Division of Pulmonary and Allergy Products.
Albuterol is used to treat shortness of breath in people with asthma and chronic obstructive pulmonary disease, he notes.
Dr. Chowdhury says that about 65 percent of inhaler users have already switched to HFA inhalers.
"These new inhalers may taste and feel different than the current CFC inhalers," he says. "In addition, HFA inhalers may feel softer than CFC inhalers."
Also, patients using HFA inhalers will have to prime and clean them to prevent the buildup of albuterol in the inhalers' nozzle. This buildup could block the medicine from reaching the lungs, notes Dr. Chowdhury.
Each HFA inhaler has a different priming mechanism and cleaning and drying instructions. So, users should carefully read the instructions before using the inhaler.
And HFA inhalers may cost more, because there is no generic HFA inhaler available yet, says Dr. Chowdhury.
Three HFA-propelled albuterol inhalers have been approved by the FDA: Proair® HFA Inhalation Aerosol, Proventil® HFA Inhalation Aerosol, and Ventolin® HFA Inhalation Aerosol.
Also, an HFA-propelled inhaler containing levalbuterol, a medicine similar to albuterol, is available as Xopenex® HFA Inhalation Aerosol.
Dr. Ira Finegold, at St. Luke's-Roosevelt Hospital Center in New York City, does not see much difference in the effectiveness of the two types of inhalers. "The end result - if you need it, does it open up your lungs? Yes, it does," he says.
However, the changeover will involve some patient education, he notes. "The old medication, CFC albuterol, was really a very nice product, because the propellant got in your body and came out of your body - it was not absorbed. And remarkably, it is a cleaning agent, so the device was self-cleaning."
The new HFA propellant is safe in the body but can clog the inhaler, says Dr. Finegold. "So, after use, these inhalers need to be rinsed out or they are not going to work correctly.”
"In addition," says Dr. Finegold, "each of the four new inhalers on the market is different in the number of times you have to prime it. There is also a little difference in feel and taste."
The discontinuation of CFC-propelled inhalers is the result of the US Clean Air Act and an international treaty known as the Montreal Protocol on Substances That Deplete the Ozone Layer.
Under provisions of this treaty, the US agreed to stop the production and importation of substances that damage the ozone layer, including CFCs, according to the FDA.
Always consult your physician for more information.
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In some cases, the only symptom is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise.
Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.
Asthma may resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections.
If it is not detected, many people with asthma do not know they have it. Consult your physician for a diagnosis.
The basic cause of the lung abnormality in asthma is not yet known, although healthcare professionals have established that it is a special type of inflammation of the airway that leads to contraction of airway muscles, mucus production, and swelling in the airways.
It is important to know that asthma is not caused by emotional factors - as commonly believed years ago.
Emotional anxiety and nervous stress can cause fatigue, which may affect the immune system and increase asthma symptoms, or aggravate an attack.
However, these reactions are considered to be more of an effect than a cause.
Persons with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult.
These problems are caused by an oversensitivity of the lungs and airways.
Lungs and airways overreact to certain triggers and become inflamed and clogged. Breathing becomes harder and may hurt. There may be coughing.
There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because muscles that surround the airways tighten, and the inner lining of the airways swells and pushes inward.
Membranes that line the airways secrete extra mucus and this can form plugs that further block the air passages. The rush of air through the narrowed airways produces the wheezing sounds.
Always consult your physician for more information.