As Asthma Inhalers Are Phased Out, Shortages Expected; Physicians
Must Prepare Patients for Switch to Ozone-Friendly Inhalers
[Posted 02/008/07]

Physicians should be aware that asthma rescue medications are in short supply as prescription drug manufacturers begin phasing out metered-dose inhalers containing ozone-depleting chlorofluorocarbons (CFCs). The FDA in 2005 ordered drugmakers to stop making inhalers with CFC propellants by the end of 2008.

Beginning in 2008, only hydrofluoroalkane (HFA) propellants may be used in metered-dose inhalers. Several manufacturers have already slowed or halted production of CFC inhalers in preparation for the switch to HFA products. This shortage is expected to become more pronounced in coming months, as Schering-Plough, through its Warrick Pharmaceutical Division, announced it would stop production of CFC inhalers this spring.

Because of the shortage, patients with nonspecific prescriptions may unknowingly be switched to alternative HFA agents. Even though HFA propellant formulations are not generically interchangeable with their CFC counterparts, there have been some reports of substitutions being made without physician approval. Accordingly, physicians writing prescriptions for bronchodilators should be sure to indicate specifically which medication they are prescribing.

Physicians should also be aware that HFA propellants may “feel different” to patients accustomed to CFC inhalers. Physicians and pharmacists should educate patients about what to expect when making the switch to avoid potential overuse, product waste, or patient dissatisfaction. (The American Lung Association has posted on its website educational materials physicians can use for this purpose.)

Medi-Cal has added HFA agents to its list of covered drugs and will only cover CFC inhalers with prior authorization. Many health plans, however, still do not cover HFA inhalers without prior authorization.

Contact: Teresa Stark, 916/444-5532 or tstark@cmanet.org.