A chemical known to harm the ozone layer is a common component in asthma inhalers, but its use is on its last breath.
Chlorofluorocarbons, or CFCs, are widely used to propel medication out of inhalers and into the airways of chronic lung disease sufferers. As part of a nationwide phase-out, it will now be illegal to manufacture or sell inhalers with CFCs.
The change will affect patients in Michigan who use metered-dose inhalers, the form of treatment that supplies a forceful burst of medication for relief. The alternative dry powder inhalers, which require patients to breath in medication, will remain legal.
A federal ban on CFCs in inhalers takes effect this month. Alternative products contain the same medications but an environmentally friendlier propellant, hydrofluoroalkane (HFA), replaces the CFCs.
The transition has been postponed and changed many times over at least a decade. Chad Mayer, a specialist at the Asthma and Allergy Institute of Southeast Michigan in West Bloomfield, said the delay is due to the approval process drug companies must undergo before new products are released.
“There are currently four brands out there that use HFA,” he said. “There’s plenty that have been produced and plenty of supplies, so there won’t be a shortage.”
A major concern for patients is the cost of the new inhalers, said Mayer. CFC inhalers come in generic form and cost $20 to $25, he said, but HFA inhalers can cost almost three times as much. There won’t be a generic version of inhalers with the alternative propellant on the market until the patents expire. That date is not set in stone, said Mayer, because the time can be shortened or companies can petition for extensions.
“There’s always a fear that patients won’t fill prescriptions because of high cost,” said Mayer. “But there are different assistance programs and coupon discounts available for the new inhalers.”
Karen Meyerson, manager and nurse practitioner at the Grand Rapids-based Asthma Network of West Michigan, said patients are also concerned that the new inhalers won’t provide the same relief. The network covers Kent, Montcalm, Muskegon, Newaygo and Ottawa counties.
“It might taste or feel different in their mouth,” said Meyerson. “There’s a softer blast with HFA. The puff might not feel as strong, but it has the same dosage and can give the same relief.”
Asthma patients have used metered-dose rescue or emergency and daily control inhalers for more than 50 years, according to the Department of Community Health, which says that 9.5 percent of Michigan adults over 18 and 9.5 percent of children under 18 had asthma last year. Detroit ranks higher than the state average: 17.3 percent of its residents suffer from asthma.
Betsy Wasilevich, an epidemiologist at the department, said asthma is most common in urban areas and among African-Americans. The potential impact of pollution on the disease is “still a matter of research.”
Michigan ranks in the upper 25 percent of asthma cases each year across the nation, she said, but there isn’t “necessarily statistical differences across multiple states.”
Data on the amount of CFC-propelled inhalers used in the state doesn’t exist. Available information about them is compiled from pharmacy claims, health plans and Medicaid, and is “fragmented,” said Wasilevich.
Since the 1990s, CFCs have been banned from use in aerosol cans, freezer refrigerants and air conditioners. Their widespread use ended when researchers identified the impact on ozone depletion, said James Clift, policy director at the Michigan Environmental Council.
CFCs contribute to a breakdown of the upper atmosphere, he said, which ultimately allows more of the sun’s radiation into the atmosphere. Without a protective ozone shield, ultraviolet radiation contributes to skin cancer, cataracts and other health problems.
“It’s a chemical that was serving its intended purpose of transferring heat very well,” said Clift. “But the destruction of the upper ozone layer is what we’re trying to address with the elimination of CFCs.”
Shortly following that discovery, most countries signed an international treaty calling for a step-by-step eradication of CFC in consumer products. HQ