Fast-acting inhalers in short supply


Asthma sufferers who rely on fast-acting “rescue inhalers” soon may be scrambling to find the gadgets that help quell their sudden, agonizing attacks.

The inhalers, which propel medicine into users’ airways, are in short supply at some hospitals and pharmacies across the country. And their availability is expected to worsen, as drugmakers make a switch from the traditional devices to inhalers that are more environmentally friendly.

The shortage centers on albuterol, a generic drug that comes in inhalers that depend on chlorofluorocarbons, or CFCs, to thrust out the medicine. Federal authorities, who are concerned about CFCs’ harm to the Earth’s ozone layer, have given producers until December 2008 to remove those inhalers from the market.

In response, some drug companies are already pulling back on production of the familiar devices. But the newer, more expensive inhalers that use hydrofluoroalkane, or HFA, to push out albuterol aren’t widely available yet. In the meantime, albuterol users are stuck with a supply shortage.

Carter High, a pharmacist at Spence Pharmacy in Fort Worth, Texas, said his drugstore has albuterol in stock. But employees in recent weeks have seen supplies dwindle.

“We were having to ration them out just a little bit,” High said. “Last week was the only time we actually got down to where we didn’t have any on the shelf.”


Hospitals across the country began noticing a scarcity of albuterol in December, when the traditional inhalers accounted for about 96 percent of the market, said Lesley Maloney, director of public health and quality at the American Society of Health-System Pharmacists.

Manufacturers have been reluctant to crank out many of the safer-for-the-ozone-layer inhalers yet, because pharmacists and consumers are unlikely to use them as long as the cheaper, CFC-based inhalers remain prevalent, Maloney said.

Still, it’s only a matter of time before asthma sufferers will be forced to make the swap. And they’ll probably experience sticker shock when they do. The generic inhalers are being replaced by brand-name alternatives that can cost three times as much.

“What we’ve seen is when the reformulated sprays go to this new delivery system, the price is much higher – dramatically higher,” said Larry Cowan, who owns Glenview Professional Pharmacy in Richland Hills, Texas. “I’m showing the new formulation’s going to cost around $30, where the previous formulation probably cost around $10.”

Lifelong asthma sufferer Suzan Steblein said the price jump could be troubling for many patients, but rescue inhalers are so vital that they’ll have little choice but to pay.

“I get one once a month,” Steblein said. “I have a stash here and there. I can definitely anticipate feeling it in the pocketbook.”

Steblein, a physical therapist, keeps inhalers at home, in her car and anywhere she spends much time. She said the prospect of a shortage is frightening, because easy access to an inhaler can halt serious breathing troubles.

“It really has prevented emergency-room trips on more than one occasion,” she said. “They’re called rescue inhalers for a reason.”


Mark Thomas, pharmacy director at Fort Worth’s Cook Children’s Medical Center, said it has gotten harder to find enough albuterol inhalers for the hospital’s patients. But so far, he’s been able to meet their needs.

Thomas’ advice to asthma patients searching for a rescue inhaler: “Keep looking, because it’s spotty right now. One pharmacy might have it, and the other might not. If they keep looking, they’ll probably find some.”

Doctors at Cook Children’s haven’t switched to the new inhalers, but they are thinking about alternatives if their albuterol supplies get squeezed further, Thomas said.

“We certainly have made people aware of the situation,” Thomas said. “Right now, we’ve just said there may come a time when we have to do some different types of therapies.”

For example, asthma sufferers could use a nebulizer in the hospital or at home to get albuterol. That’s a larger machine that provides treatment without using a CFC-based propellant, but its size makes it impractical for on-the-road emergencies.

Also, some patients who depend heavily on their rescue inhalers could make better use of preventive treatments such as corticosteroids, Maloney said.

Inhalers containing the preventive drugs already use the CFC-free propellant and aren’t affected by the ban.

Neither are over-the-counter inhalers, such as Primatene Mist. But a federal panel in January made a recommendation that set the stage for a possible prohibition of those devices as well.

“This issue is an opportunity for pharmacists or other healthcare providers to educate patients or talk to them about the proper treatment of asthma,” Maloney said. “They need to start talking to their patients about it, and not saying, “Well, we have a whole other year to worry about this.”‘

(c) 2006, Fort Worth Star-Telegram.

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Distributed by Knight Ridder/Tribune Information Services.

AP-NY-05-19-06 0606EDT