November 13, 2013
Asthma, COPD Patients Must Switch From Final Two CFC Inhalers This Year

Washington, D.C.—The final two inhaler medical products containing chlorofluorocarbons (CFCs) will no longer be available for purchase after the end of this year, and patients using them should be urged to talk to their prescribers and counseled about alternatives.

Combivent Inhalation Aerosol and Maxair Autohaler, used in asthma and chronic obstructive pulmonary disease (COPD), are being phased out as the FDA complies with an international treaty to protect the ozone layer by ending worldwide production of numerous substances, including CFCs, which contribute to ozone depletion.

Users can be advised that the two CFC inhalers purchased as of December 31, 2013, are all right to use until their expiration dates, according to the FDA.

Boehringer Ingelheim Pharmaceuticals told the FDA that Combivent Inhalation Aerosol actually was discontinued this past summer to begin transitioning patients to a new product, Combivent Respimat, which contains the active ingredients ipratropium bromide, and albuterol sulfate—without CFCs. It was approved by the FDA in 2011.

Maxair Autohaler, which will not be available after the end of the year, contains pirbuterol, which is also a bronchodilator and is used for the treatment of bronchial spasms in patients with asthma or COPD, according to the FDA. Public health officials suggest that patients could use alternative inhalers that contain other bronchodilator medicines, such as albuterol or levalbuterol, but do not use CFCs as a propellant to move the medicine from the inhaler.

“For more than two decades, the FDA and [Environmental Protection Agency] have collaborated to phase out CFCs in inhalers—a process that included input from the public, advisory committees, manufacturers, and stakeholders,” said Badrul Chowdhury, MD, director of the Division of Pulmonary, Allergy and Rheumatology Products, FDA Center for Drug Evaluation and Research.

The most widely used inhaler—albuterol CFC inhaler—was phased out in 2008 and replaced with products that use hydrofluoroalkanes (HFAs). The FDA has a webpage with information about drug treatments for asthma and COPD that do not use chlorofluorocarbons.

With more than 25 million Americans diagnosed with asthma and another 15 million with COPD, the phaseout has had wide effect and has generated some concerns.

“While all FDA-approved inhalers currently on the market have been shown to be effective, there are some differences between the products,” the agency notes. “For example, products propelled by HFA may taste and feel different than the spray from CFC-propelled inhalers. Although some consumers note that the spray from an HFA inhaler feels less forceful, this does not mean that the medicine is not working.”

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