Time is running out for patients who use albuterol inhalers to replace those propelled by chlorofluorocarbons (CFCs) with ones that rely on eco-friendly hydrofluoroalkane (HFA).

After December 31, 2008, CFC inhalers will no longer be available in the United States. The federal Clean Air Act mandated the switch because CFCs have been shown to cause damage to the ozone layer. The change also conforms to the requirements of an international treaty, the Montreal Protocol on Substances that Deplete the Ozone Layer.

Three HFA-propelled albuterol inhalers have been granted FDA approval as safe and effective CFC replacements: 

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  • Proair HFA Inhalation Aerosol (Teva Specialty Pharmaceuticals)
  • Proventil HFA Inhalation Aerosol (Schering-Plough), and
  • Ventolin HFA Inhalation Aerosol (GlaxoSmithKline).

Each has a unique formulation, according to the Allergy & Asthma Network Mothers of Asthmatics (AANMA).

Xopenex HFA Inhalation Aerosol (Sepracor), which dispenses levalbuterol, is a fourth approved choice. Patients may need retraining to use the HFA inhalers and reassurance that they actually work. For example, the new devices deliver warmer, softer puffs than the cool, more forceful sensations that users of CFC inhalers are accustomed to, the FDA warns.

HFA inhalers also require more maintenance than CFC devices. They have to be primed before each use and cleaned on a regular basis to avoid drug buildup that could prevent the albuterol from reaching the lungs. These maintenance procedures vary with each manufacturer.

“There are critical differences between CFC and HFA inhalers that patients need to be made aware of to ensure these medications are used properly,” observes AANMA president Nancy Sander. “Patients need an opportunity to make the switch in a medically responsible way.”