Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Saturday, February 10, 2007

The Ozone is Falling, the Ozone is Falling!

Global warming is real. Also, I understand the critical role of the ozone layer in protecting life on earth from harmful ultraviolet radiation. Both of these important issues are the direct result of human activities, primarily the byproducts of the combustion of fossil fuels, although chlorinated fluorocarbons (CFCs) from refrigeration units are also implicated. I have no problem with these scientific assertions.

Here's the thing, though: the generic albuterol inhaler -- an effective, cheap, useful medication for which I write dozens of prescriptions a month -- is being discontinued because the propellant contains CFCs!

CUT ME A BREAK!!

Are they trying to tell us that all those little itty bitty inhalers with their few grams of propellant apiece are somehow so dangerous to the environment that they need to be banned, while the SUVs and Hummers -- you know, the ones with the giant internal combustion engines burning fossil fuels -- our patients are driving to the drugstores to pick up their replacement prescriptions for brand name inhalers that use environmentally friendly CFC-free propellants (but don't seem to work as well, even after patients become accustomed to the lesser "whoosh") are NO BIG DEAL?

Oh; did I mention that because the CFC-free inhalers aren't generics, they're much more expensive? Gee. What a lucky break for the companies that happen to manufacture them. Just another example of the haves further increasing their lead over the have-nots on the backs of all of us.

Please excuse me while I go plotz.

32 Comments:

At Sat Feb 10, 05:48:00 PM, Blogger Dr. K said...

That has to be one of the most amazingly stupid things that I have read in a long time (the inhaler ban, not your writing!).

 
At Sat Feb 10, 08:30:00 PM, Anonymous Judy said...

Crapo! This just sucks. I use it and my daughter uses it, and it's cheap. This is going to be a real loss for my daughter if it's replaced by someting not quite as effective because she has bad asthma.

Well, one strike for the drug companies. Gosh, I hate them. In protest, I don't take anything they sell unless I absolutely have to. If I can live without it, I do.

 
At Sun Feb 11, 10:27:00 AM, Blogger TBTAM said...

I did a little digging...

1. The FDA has been talking about a ban on these propellants since 1998. Why Wyeth never got its act together to make an alternative so they could keep the OTC market is beyond me.

2. A lot of promnent allergy docs hate primatene becuase they think it delays folks in getting proper treatment. But I can tell you, that as an asthmatic, I have more than once used the stuff in an emergency basis when my aluterol was out and the Pharmacy was closed. We absolutely need an OTC inhaler.

3. I predict what will happen next is a push to make albuterol inhalers OTC before they go generic.

One could argue that they are safer than the epinephrine-based primatene...

 
At Sun Feb 11, 10:32:00 AM, Blogger #1 Dinosaur said...

TBTAM: Of course they're safer than OTC epinephrine, and I agree with OTC status for albuterol. It's the outright banning of the cheaper, more effective CFC propellant that I find so nonsensical.

 
At Mon Feb 12, 01:06:00 AM, Anonymous scalpel said...

Even if one accepts that 1)global warming is in fact happening (not just a blip in the data) and 2)that human industry is responsible, it still is unclear to me that even the most aggressive restrictions that are being proposed would affect the process.

In the entire course of human history have humans ever been able to purposefully enact a climate change? I think not. Nature > humans.

I think our efforts would be better served by learning to adapt to the inevitable increase in temperatures. This one restriction on albuterol, for example, will probably kill more people from asthma than it would save by the microscopic theoretical climatological benefit.

 
At Mon Feb 12, 04:11:00 AM, Blogger The Peanut Gallery said...

That is ridiculous.

 
At Mon Feb 12, 05:27:00 PM, Anonymous Anonymous said...

Dino, most often you're right-on and I usually agree with your assertions. However, as a scientist, please PLEASE step away from the table of Algore Kool-Aid and think . . . http://www.clearlight.com/~mhieb/WVFossils/ice_ages.html

 
At Fri Mar 16, 11:46:00 PM, Anonymous RJS said...

#1 Dinosaur,

There is (at least) one generic for Ventolin HFA. It's called Proair HFA, and it has been around for a little while. (It has the same NDC code as Albuterol HFA -- they merely changed the name about a year ago.)

So it does exist. Apparently it won't give you the same rush as the CFC ALH, though. (Don't know from first-hand experience, just what I've been hearing from our patients.)

 
At Sat Mar 17, 12:53:00 AM, Anonymous Dancingsloth said...

More of a reply to RJS, I suppose,

ProAir isn't actually a generic for Ventolin HFA (it has BX rating from the FDA, so in most states it can't be substituted without a physician's OK). Sure it does the same job and is (marginally) less expensive than the others, but thanks to the FDA's arcane system, it's not actually a generic. If, however, the physician writes for 'albuterol HFA,' then I suppose you get to pick whichever rx the patient's insurance likes best.

 
At Sat Mar 17, 01:15:00 AM, Anonymous RJS said...

Ah, interesting. In the two states I spend my time in, ProAir HFA is always substituted for Ventolin HFA. We've not had any complaints.

Given the relative newness of the product, and the importance it will have in the next few years, I wouldn't be surprised to see the BX changed to an AB -- assuming it passes muster, of course. It'd be in Ivax's best interest to push in that direction now, if they aren't already.

Proair is considered a generic by every insurer I've ever dealt with in terms of copayments, which is perhaps the most relevant thing for #1 Dinosaur's patients. (Medicare D patients excepted.)

 
At Sat Mar 17, 11:12:00 AM, Anonymous Anonymous said...

RJS... since Proair is NOT an AB-rated generic, you CANNOT legally substitute if for neither the Ventolin HFA or the Proventil HFA. Also, from a pharmacist's perspective, I can tell you that not only is Proair considered a brand name by every insurance company lately, I even had the joy of finding out last week that at least one plan lists is as non-formulary, with a $30 copay, preferring instead that we dispense Proventil HFA, which turned up to have a $16 copay (still a brand name copay). I don't know where you got your info from, but it's out of date mon ami.

 
At Sat Mar 17, 11:53:00 AM, Anonymous RJS said...

"RJS... since Proair is NOT an AB-rated generic, you CANNOT legally substitute if for neither the Ventolin HFA or the Proventil HFA. Also, from a pharmacist's perspective, I can tell you that not only is Proair considered a brand name by every insurance company lately, I even had the joy of finding out last week that at least one plan lists is as non-formulary, with a $30 copay, preferring instead that we dispense Proventil HFA, which turned up to have a $16 copay (still a brand name copay). I don't know where you got your info from, but it's out of date mon ami."

I find the inconsistency interesting. I had a Ventolin HFA drug rep come visit me last week, and she told me that Proair COULD be substituted -- and that it was the only substitution available for Ventolin HFA.

We've been doing it for over a year now -- ALH HFA in any form still isn't very popular -- I'll have to look into it more closely this week.

And in both Massachusetts and New Hampshire, Proair HFA is dispensed as a DAW 0, with a generic copayment. I've never seen a copayment for the drug that wasn't.

Strange.

 
At Fri Mar 30, 01:16:00 PM, Anonymous Anonymous said...

just picked up my ozone friendly inhaler today. i was not informed by my doctor or the pharmacy that my cfc had been switched to the hfa until i picked it up. 43.99 is what this costs me now-ughhh.

 
At Fri Apr 06, 02:33:00 PM, Anonymous Anonymous said...

I just picked up mine as well.. 1/2 the size, 4 times the price. I know I feel better about the ozone. PS, Dear Dinasaur...Global warming maybe, but the fact that our sparse population of humans could possibly have the slightest thing to do with it? You cant be serious...

 
At Tue Apr 10, 05:08:00 PM, Anonymous Anonymous said...

Antoerh scam perpeterated on the american people by the FDA and teh drug manufacturers. Pay "brand name" prices for an old drug. I suggest writing letters to your congressmen and the FDA....

 
At Sat Apr 28, 02:07:00 PM, Anonymous Anonymous said...

IVAX ProAir is 100% PURE CRAP (I believe this is due to the higher concentration of ETHANOL in it vs. any other HFA inhaler)...

Read the comments of several hundred asthma patients who feel the same way at:

http://tinyurl.com/3bul5u

 
At Wed May 23, 04:58:00 PM, Anonymous Anonymous said...

afer also paying 44 dollar for the pro air and it only last 3 weeks versus 6 for my husband I ahve deiced that yes the ozone will be better because they are going to let all the asthmatics dye off. THIS proair DOESNOT work!!!

 
At Wed May 23, 08:54:00 PM, Anonymous Anonymous said...

ProAir, and Proventil HFA inhalers are the ones I have used so far. Both, are completely worthless. I am sure if they are giving the correct dosage of medication I am now overdosing constantly. Prior to the change I was using a CFC inhaler (usually a Warick one, but I preferred Ventolin if I could get it). I would maybe take one puff and it would sometimes alleviate the problem. Two usually though. With this Proair P.O.S., I have to use it almost twice as often as I did prior to the HFA devices. It is ridiculous. Additionally, the device clogs constantly. Or, if it doesn't clog runs out of medication/propellant WELL BEFORE the listed 200 inhalations it is rated for. The device is simply ineffective at providing relief for the symptoms it is designed for. A far INFERIOR product than the previous generation of CFC based Aerosol Inhalers.

 
At Mon Jun 11, 04:05:00 AM, Anonymous Anonymous said...

I am a relatively healthy 44 year old asthmatic. Proair does not work at all. For the first time in decades I am worried about my asthma control as the warrick brand was serving me so well.

 
At Mon Jun 11, 03:17:00 PM, Anonymous Anonymous said...

I have been using the CFC inhalers for 15 years, 2 puffs in the AM 2 puffs at night and I live a normal active life. They switched me over to HFA ProAir and no matter how many puffs a day I take my lungs are constricted and I am wheezing up the stairs and on the golf course or doing yard work. I found an old CFC inhaler with some puffs left in it and 2 puffs later and back to normal. The ProAir does not work no matter what they say. I am all for make the enviroment a better palce, because that probably has some thing to to with the increase in asthma. However lets wait until we have an equal or better replacement before we switch.

 
At Wed Jun 20, 02:53:00 PM, Anonymous Anonymous said...

Here I get to be Odd man out. I prefer the HFA inhaler not for the hippy tree hugging reasons, but the CFC inhaler was too forceful and would actually cause an episode to worsen so much so that I wouldnt use it. I'd go meditate on my breathing till I could. I switched soon as my MD had me use one for a spirometry and never looked back.

 
At Thu Aug 16, 06:30:00 AM, Anonymous Anonymous said...

This is really upsetting. CFC Albuterol is the choice rescue inhaler for asthma attacts. ProAir HFA apart from the side effects, didn't relieve my asthma attack at all. We should start a class action lawsuit, because they are taking away a product that saves lives and not providing us with any suitable alternative.
It was mentioned at the petition http://www.thepetitionsite.com/petition/300594068
"I learned that CFC manufacturing IS GOING AWAY. Ultimately, there will be no CFCs". What about us asthma patients. There is absolutely no satisfactory replacement. CFC Albuterol is a Medical product that should be considered essential, and not banned. Asthma patients are panicking, you can read it at the petition.
Something must be done about this immediately. HFA ProAir is terrible and should be banned or recalled!

 
At Thu Oct 04, 10:58:00 AM, Anonymous Anonymous said...

My wife is unable to breath on this new proair hfa. She is also getting terrible leg cramps since she has been on this. The warrik one was far superior in our minds. Another pettion out there as well is at :
http://www.ipetitions.com/petition/saveCFCinhalers/index.html

 
At Fri Oct 12, 01:32:00 PM, Anonymous Anonymous said...

Please sign this petition and let the FDA know how you feel about taking the medication that we have relied on for 25 years. You will also find other interesting articles including a recent publication by the US News and World Report.

http://tinyurl.com/yphmp4

 
At Tue Dec 04, 12:48:00 AM, Blogger frustrated said...

Help, does anyone know if you can effectively put Albuterol (intended for a nebulizer) into an atomizer? The new formulation is NOT WORKING and there appears to be no medically sanctioned alternative. Thanks for any help you might be able to give me.

 
At Fri Dec 07, 11:59:00 PM, Anonymous Anonymous said...

This ProAir HFA inhaler doesn't work. How can "they" do this??? This product barely controls my asthma on good days--I am so scared that I will have to rely on this some day as a "rescue" inhaler. This thing is a joke. Guess I'll have to start carrying a nebulizer around with me--think someone will invent one that will fit into my pocket and plug into my cell phone charger in my car???

 
At Mon Feb 18, 12:05:00 AM, Blogger tibbetts said...

If CFC inhalers are no long being produced, you are going to see a lot of deaths in the United States primariliy because the HFA inhalers CAUSES asthma symptoms - it does NOT alleviate them! I am one who has chest tightening and coughing episodes when using the HFA inhalers. With so many people in the US having asthma you'd think the government would step in and try to protect it's people! One reason why so many of us have asthma is because of all the pollution in the air and now in trying to protect the environment we are taking away a medication that a lot of individuals are in need of. Those of us who use the "fast acting" inhaler will have to start walking around with our nebulizers - great now we'll use more electricity or batteries (difficult to dispose of) - Please reconsider this decision and let us all breath well!

 
At Mon Apr 07, 02:53:00 PM, Anonymous Anonymous said...

This is the most ridiculous thing i have ever heard of in my life. I have SURVIVED off of albuterol for the past 10 years of my life and ive had this new pro air shit for two days and already have an infection... I like what the other comment said about having to carry a nebulizer with me, im gonna have to do the same thing. This has put my marathon training on halt. Of all the things to ban in order to "help" the ozone layer they pick life saving devices..... I say lets get letters written and voices heard. If anyone else agrees please email me dglovewmu1983@yahoo.com Thanks. Jeannette

 
At Sun Jun 15, 10:05:00 PM, Anonymous Anonymous said...

depending on your state and insurance, ventolin hfa can actually be cheaper than all other albuterols available. PLUS it is the FIRST and ONLY albuterol to have a built in dose counter, so you know when your medication has run out. as you asthmatic know, running out of your rescue inhaler is extremely unsafe and life threatening. if you have the opportunity, i'd ask the price differences and go for the Ventolin when possible!!!!

 
At Tue Jul 29, 12:03:00 PM, Anonymous Anonymous said...

Hi everyone. I absolutely agree with how crappy the ProAir HFA is along other new "environmentally safe" products. First, how can CFC's even escape is we are inhaling them? I have decided to look elswhere for products. I looked into a website called CanadaDrugs.com and they offer Ventolin for about 22 bucks for 200 doses, without insurance! I placed my order last Friday. However, I noticed on my confirmation email that the product actually says "Ventolin HFA". To the best of my knowledge, the ProAir is an entirely different medication. Hopefully, this Ventolin will work much batter. I ordered 5 Ventolin inhalers and one generic. When I get the products, I will offer my opinion. I went to CanadaDrugs because I read somewhere that they elude the FDA. To be continued...

 
At Mon Jan 26, 03:33:00 PM, Blogger craigsmuse said...

I too am frustrated and disgusted at how the same drug reformulated can now be touted as "new". It doesn't work! I run out long before the month is up(if I used it according to "directions" I would run out sooner)but my insurance will not refill it until 30 days has elapsed, so I can literally wheeze to death while I wait for a refill. I have had to go back on Singulair just to manage my symptoms. I also got harassed by Blue Cross because I now take this Proair and it costs them more.
I also noticed they are still pushing Advair even though it causes death-they are supposed to take it off the market.
Just another case of the drug companies running Capital Hill. Hope this changes with the new administration.

 
At Wed Feb 04, 08:04:00 PM, Anonymous Anonymous said...

I just need to get this out. I complained to my ins company because ventolin requires an authorization.
this means that I must use 2 of the alternatives they require. One alternative is albuterol which isn't available (although the ins says it is available in hfa)another is serevent discus, makes me choke. The others are proair; no good and my copay is $20 for it; they also suggest proventil which is $35. I emailed the FDA and received bull in their answer. I'm allergic to aspirin but sometimes I think it would be easier to go that way rather than choke to death.

 

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