ST. LOUIS – With the year 2009 drawing close, people who suffer from asthma and other respiratory ailments only have a few days before the last of the inhalers that use ozone-depleting chemical disappear from pharmacy shelves and are replaced with new “green” devices.

Because the new devices are more expensive, the switch has raised the possibility of last-minute hoarding. It has also triggered concerns that the added expense of the new inhalers – which could cost an extra $25 per device – may lead low-income patients to cut back on purchasing needed prescriptions.

“It’s possible people may skimp on their medicine because of the cost,” said Dr. Bradley A. Becker, co-director of the Asthma Center for Children at Cardinal Glennon Children’s Medical Center. “Clearly that would not be a good strategy because you might end up in the emergency room.”

Many area doctors have been prescribing the new inhalers for several months now, helping their patients transition to the devices, which use the more environmentally friendly propellant hydrofluoralkane (HFA) and deliver the quick-relief drug albuterol.

Some physicians and pharmacists, however, say they wouldn’t be surprised to see patients rush to snag up the old inhalers, which utilize harmful chlorofluorocarbon as a propellant. The last day for the old inhalers to be sold is Dec. 31.

The new HFA inhalers can cost as much as five times the price of the old ones. That’s because there is currently no generic version available.

Most HFA inhalers cost anywhere between $30 and $60, whereas the old inhalers are priced between $5 and $25, public health groups report.

The American Lung Association estimates that more than 20 million people in the United States have asthma.

The old inhalers are being phased out as a result of the United States’ participation in the 1987 Montreal Protocol, an international treaty to ban substances damaging the Earth’s ozone layer. After the agreement was signed, drug manufacturers were given an extension to develop new “green” inhalers.

Currently, the U.S. Food and Drug Administration has approved three albuterol inhalers that use the HFA propellant – Ventolin, Proventil and Proair. Albuterol inhalers are frequently used to help relieve asthma, but are also used by people with emphysema, chronic bronchitis and chronic obstructive pulmonary disorder. Albuterol provides relief by opening the airways in the lungs, but it does not prevent asthma attacks from occurring like some other drugs.

The extra time between the ban on CFCs and now has also given doctors time to help patients transition to the new inhalers, which function quite differently from their old counterparts.

In general, the new inhalers deliver the medication with a softer puff than the old ones. That’s led to some confusion among patients about the devices’ effectiveness, local doctors say.

“Many say that they feel like the inhaler isn’t delivering the medicine,” said Dr. Mario Castro, a pulmonologist and associate professor of medicine for Washington University’s School of Medicine. “Others feel like it doesn’t work as well. Part of that is an expectation and not really a reflection on how the inhalers work.”

The FDA has found that the new inhalers are safe and work just as well as the old ones when used correctly.

And there’s the rub, some doctors say. The new inhalers operate differently from the old ones.

For starters, the new inhalers must be primed more often than the old CFC inhalers. Priming is a test spray away from the face. Different inhalers have different priming requirements.

The new inhalers also must be cleaned more frequently because it tends to get clogged.

“The analogy I like to use is that the spray is lot like what you would see with spray starch or a window cleaner,” said Dr. Theresa Prosser, a professor of pharmacy practice for the St. Louis College of Pharmacy. “If the hole becomes clogged, the mist won’t come out. It’s the same way with these new inhalers.”

Prosser said patients that use inhalers should talk to their doctor or pharmacist before using the new inhalers. Most will be happy to show them how to use and clean the HFA inhalers, she said.

Since getting a new inhaler will require a new prescription, Prosser also advised that patients not wait until the last minute to try to make the transition if they haven’t already.

“Things will go so much more smoothly if you just talk to your doctor in advance,” she said.

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(c) 2008, St. Louis Post-Dispatch.

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AP-NY-12-26-08 2147EST