"CFC" stands for chlorofluorocarbon -- a class of chemicals that depletes the ozone layer. The ban on CFCs is required by The Montreal Protocol on Substances that Deplete the Ozone Layer.

Protecting the ozone layer is, of course, a good thing, and there are alternative medications for asthma. Many people have already made the switch -- but there have been rumblings of dissatisfaction with the new options.

The HFA inhalers, which use the propellant hydrofluoralkane to deliver the medication -- behave differently than the CFC inhalers. They require a different method of use and more frequent cleaning, and some users claim they don't work as well.

They're considerably more expensive -- no generic version is available. For millions of mild asthma sufferers, what's worst of all is that there's no over-the-counter option.

Asthma is a life-threatening lung disease that affects more than 20 million Americans. With proper treatment, however, it can be well-managed. And many people have been managing their asthma very well with the CFC bronchodilators that will soon disappear from drug store shelves.

An education effort is under way. Those who get the message early enough will have time to learn how to use an alternative to their CFC inhaler -- and budget for the extra bite it will take out of their pocketbooks. It seems inevitable that for some, the adjustment will be tricky, if not difficult.

For those who don't get the message, the scenario is grimmer. People making a late-night trip to the 24-hour pharmacy when their wheezing gets bad won't find their tried-and-true inhaler on the shelf. They'll either have to suffer through their attack until they can see a doctor or head for the emergency room. This is likely to be highly stressful -- and stress itself can aggravate asthma.

I'm all for reversing the damage we humans have done to the environment -- but it seems that policy makers have gotten their priorities a little out of whack. Heavy industrial polluters can buy "carbon credits" to offset the damage they're allowed to continue doing. How about letting asthma patients buy offsets for the privilege of continuing to use the meds they prefer?

How about extending the period for phasing out the CFC inhalers until a reliable OTC alternative is available? Until a generic HFA inhaler is available?

Accommodations such as these would probably result in very small negative effects on the ozone layer, but they would be a great service to a population that simply wants to live a normal, healthy life.

The reason they probably were dismissed out of hand is that certain pharmaceutical companies stand to enlarge their profits handsomely when January 1, 2009, rolls around.

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From Lynn Fischer-Dike:

The HFA inhalers are not as effective as the CFC inhalers -- 3 out of the 4 HFA inhalers contain ethanol, a known toxin to some asthmatics causing severe broncospasm.

I am allergic to the new formulation as many others are. It doesn't matter what the FDA says -- unless you are Asthmatic you cannot compare the two.

If you've had difficulties with the new HFA inhalers, please sign the petition to save CFC inhalers. Thank you.

http://www.ipetitions.com/petition/saveCFCinhalers/

From Barbara:

Does the inhaler really damage the ozone when we are actually praying the stuff down into our lungs?

I believe that there will be a vast increase in deaths from asthma. All medications for asthma have been priced beyond the reach of many, many people, including myself.

The problem is that folks with respiratory problems cannot speak up for themselves. (Can't get enough air down to raise a protest).

Thanks for the chance to voice my opinion.

From Sue Benson:

These inhalers are called "rescue" inhalers for a reason--to open asthmatic airways and help people breathe. How basic is the need to breathe???

I do not like the new HFA inhalers because they plug up too easily, and do not work as well. I have used them also in maintenance inhalers (FloVent), and it is very difficult to keep them flowing right.

I am so disturbed because the greenies want to make us suffer these new, inferior meds, rather than letting us use the ones that work the best for us. What about all the diesel trucks, large and small, that spew soot into the air?? And factories?

From RSK:

I enjoyed reading your article about the FDA ban on over-the-counter epinephrine inhalers for asthma.

I have been using such inhalers since at least 1970, and still remember what a God-send they were when they first came out, eliminating the need for me to carry around bulky and embarrassing "atomizers" which were very messy and hard to maintain.

For nearly forty years, my asthma has been under complete and comfortable control, using this medicine, and with no side-effects that have caused any problems. My doctor (who is a very sensible physician) has, over the years, asked me to TRY albuterol instead, and I've found, as, apparently, many other patients have, that it is not AS effective, at least in my case, in providing immediate relief.

Aside from the ferocious anger I feel for the arrogant way in which government officials, who, on the one hand, insist that they wish to lower health costs, turn around, on the other hand, and ELIMINATE an extremely low-cost solution with a PROVEN track record of so many long years, I also am very fearful about changing to different medications with unknown risks.

The nurse who works for my doctor assured me that a sample he gave me of an FDA-allowed compoud "was one that did not give HER anxiety problems"--in other words, many of the PRESCRIPTION medications which we are now forced to use DO have side-effects which can upset my mood, lead to nervousness, irritability, etc.

If this was because they discovered something intrinsically HARMFUL in the treatment, that would be one thing; however, the ban stems from a ridiculous concern for greenhouse gases--the tiny puffs of asthmatics' nebulizers and inhalers are NOT significant contributors. Other than that, the FDA panel only decreed that it would be NICER if everybody had a prescribed medication from a doctor, rather than managing their own treatment at a fraction of the cost.

To these know-it-alls, someone should point out that doctors originally TOLD asthmatics like me to use epinephrine, and that originally, this course of treatment WAS prescribed to me, professionally--when I was still a child! I *have* tried improvements, and I'm perfectly happy with the treatment plan that has been working for so long.

My own solution, unsatisfactory though it is, has been to stockpile as much of my medicine as I can, in the hope of "holding me over" until I am old enough to qualify for medicaire. I do not have health-insurance, and I cannot afford to pay four times as much money in order to continue breathing smoothly. I am only hoping that the expiration dates stamped on the medicine is as conservative as I think it is.

I wish the know-it-alls on the FDA panel were required to run around desperately and spend all of their good money in a desperate effort to keep BREATHING.

From V. Ewing:

First off--love the title of the article.

I have tried the newer type inhaler, and find it useless. Nothing is scarier than having an asthma attack, and having one's asthma inhaler not be effective.

A friend who had similar experience with the newer inhaler was put back on her albuterol, at a large and famous medical center. She was told that the center had so many complaints about the new type inhalers, they were conducting an in-house study on them, with early indications the patients' complaints were valid.

This is a well-meaning law, but alarmingly dumb.

From Charley Lawson:

Until the Gov. stops flying those planes over my house every 5 Min. spewing out the crap in the fuel they use 24 hrs a day, I will not worry about my little inhaler!