Asthma Inhalers and the Environment

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Over the past several years, many people with asthma have faced a transition. The Montreal Protocol is a treaty that phased out production of chlorofluorocarbons. Chlorofluorocarbons or CFCs are used as refrigerants and as propellants in inhalers. Unfortunately, they have been a major cause of ozone depletion. The ozone layer limits the amount of the Sun's radiation that reaches the Earth and the depletion of this layer has caused thinning and a large hole that is likely responsible for worldwide increasing levels of the most lethal skin cancer, melanoma. As of December 31, 2008 most CFC inhalers were no longer being made.

Since the 1990's dry powder inhalers have been available. These inhalers do not require a propellant at all. The most popular dry powder inhaler in this country is the Advair Diskus (fluticasone and salmeterol.) Other DPIs include Asmanex (mometasone), Pulmicort (budesonide)  and Foradil (formoterol.) All of these inhalers are used as maintenance, not rescue medications.

Until recently, all rescue/quick relief inhalers in the U.S.used CFC's. Now they still use a propellant,  HFA (hydroflouroalkane) that is not harmful to the ozone layer. Unfortunately, while some people have transitioned easily others do not like the change. HFA rescue inhalers include Provental, Ventolin and Proair which are all forms of albuterol. In studies, HFA inhalers seem to have better or equal lung deposition when compared to older inhalers. In other words, the propellant does it job in delivering the medication where it is needed. However, using an HFA inhaler is a different experience if you are used to the older inhalers. The puff of the inhaler is softer and the taste is slightly sweet. Some people feel as if they do not get the medication. This is most likely because the lighter puff. Another difference is that HFA propellant can clog the small hole where the medication exits. It is recommended that users remove the canister and rinse the container under warm water on a weekly basis.

The good news is that there are actually more alternatives and it is actually easier to control asthma than ever before.