Since they have removed the CFC's from inhalers, my albuterol does not seem to work as well? Why is that?
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The CFC version produced a fast, cold jet. The HFA version produces a slower, warmer cloud. I've only had the HFA version myself. Because the CFC and HFA inhalers have different characteristics, there seems to be a shift in the medications available from MDIs (inhalers) to unit doses for nebulizers. It's just easier for the manufacturers to make unit doses than it is to re-tool their MDI production. The HFA version requires the manufacturers to change the amount of medication that is dispensed with each inhalation to comply with the change in aerosol characteristics. Maybe there is a different amount of medication coming out of your inhaler, although that shouldn't be happening. The trouble is that my Salbutamol (Albuterol) is 100 mcg/inhalation, the same as the CFC version would be. That's supposed to mean that I get 100 mcg with each inhalation. If you took nebulizer treatments, you would likely be taking 0.5 mg (500 mcg) treatments to get the same effect.
Aerosol has to deposit deep in your lungs to do anything for you. In the past, 100 mcg/inhalation x2 inhalations was a standard treatment for MDI Albuterol. 500 mcg was the standard treatment for nebulizer (SVN) Albuterol. Maybe the CFC and HFA doses are similar, but there is less deposition in the lungs with the HFA? I always take 2 inhalations and the effect is variable. Sometimes I shake and sometimes I keep coughing like mad. The actual amount of drug that makes it to where it needs to go is hard to determine. I think it is difficult enough that HFA inhalers might not be tested as thoroughly as they might need to be, in order to get the same amount of medication to the patient.
One solution, although an inconvenient one, would be to ask your doctor about getting a nebulizer and the unit dose version of your medication, if you use MDI medication daily.
If you use it for rescue (like me), maybe you should talk to your doctor about what to do if it isn't effective. I personally, as a health care professional, know that my medication is somewhat safe and have used it on myself in ways not recommended to get me through bad episodes. I don't recommend that. Like I said before, sometimes it works very well and sometimes not much at all. After six inhalations and things are still fairly bad, what do you do? I'm the world's worst patient, but like most people with asthma, I don't want to go to the hospital. It seems wasteful to have to go to the ER to get a neb treatment, if the MDI doesn't work right.
In my opinion, if I was not an RT, I would want a nebulizer. You can ask you doctor to change you to one, if you are not confident in your MDI. There are ultrasonic nebulizers that are fairly new. They use unit doses and are supposed to have great aerosol density, are cordless, and fairly small. Regular nebilizers can be used with cordless air compressors. Also, there is a dry powder inhaler that was recently approved for use during acute asthma attacks.
If I don't have confidence in my safety net, then I think it needs to be changed. Asthma sometimes is more than a properly functioning MDI can handle, so it makes it that much more hazardous when our MDIs are not up to the job. There can't be more than a few grams of CFC in an MDI. That won't do anything significant to the hole in the ozone layer.
I don't really have an answer to your question but I think it is important that people speak up about this. My daughter is going through the same thing--it is scary for her that the inhaler isn't working as well as the old kind. The pharmacy didn't even bother to tell us what was going on--they just switched it.
According to the American Lung Association web site, the new HFA mist is just as effective but the mist is less forceful and warmer. My daughter uses a spacer with her inhaler so the force of the mist is not the issue--it has to be the new ingredients.
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