How Is the Ban on CFC Inhalers Affecting Asthma Patients?

[Shogun]

Date updated: June 21, 2007
Lisette Hilton
Content provided by Revolution Health Group

Beginning Dec. 31, 2008, one of the mainstays of asthma treatment — albuterol metered-dose inhalers — will no longer be available. The U.S. Food and Drug Administration (FDA) banned their production and sale in the U.S. because they contain chlorofluorocarbons (CFCs), an ozone-depleting substance.

Scientists associate CFCs with depletion of the Earth's protective ozone layer. Most aerosols dropped use of CFC propellants more than 25 years ago. Under the terms of the Montreal Protocol on Substances That Deplete the Ozone Layer, the U.S. ended production and importation of CFCs for all commercial applications in 1996.

To prepare for the new reality, many with asthma who use inhalers have begun switching from CFC inhalers to hydrofluoroalkane (HFA) inhalers — which deliver albuterol minus the CFCs.

But the transition has not been seamless. The main reason: HFA inhalers aren't available in generic form and are thus more expensive than CFC inhalers. Even those with prescription coverage are paying higher out-of-pocket costs for HFA inhalers than for CHC inhalers.

A second reason may have to do more with perception than cost. Some people believe that CFC inhalers are more powerful than HFA inhalers. But many doctors disagree, saying that HFAs are just as good — if not better — than their CFC cousins.

Both offer same 'bang for the buck'

There is little difference in terms of the "bang for the buck" between the two types of inhalants, says Sheldon Spector, M.D., clinical professor of medicine in the Department of Medicine at the University of California, Los Angeles (UCLA). "You're still using a metered-dose inhaler," he says. (A metered-dose inhaler is a propellant-driven delivery mechanism for inhalation of asthma medications, according to the American Academy of Allergy, Asthma & Immunology.)

To prove to patients that they are getting the same effect with the HFA inhalers, Spector gives his patients a pulmonary function test that shows how both deliver the same results.

HFA and CFC inhalers are also similar in shape and size. The main difference? They have a slightly different smell and taste, and the HFA mist is a little less forceful and warmer coming out of the inhaler, according to the FDA.

HFAs also have some little-known advantages over CFCs, says Richard W. Honsinger Jr., M.D., an internist, allergy and immunology specialist and clinical professor at The University of New Mexico in Albuquerque. HFAs, for example, work better than CFCs at high altitudes and also tend to hold their pressurization better in cold weather.

And if you don't like either type of inhaler — what then? Nebulizers deliver fine liquid mists of medication through a "mask" that fits over the nose and mouth. These are often used by infants and patients who can’t use inhalers. Other options include rotary inhalers and dry-powder inhalers that deliver asthma medication without CFCs.

Cost differences

"The only reason I like the old [CFC] inhalers is that they’re cheaper," Honsinger admits. Case in point: HFA inhalers generally cost between $30 to $60 vs. $5 to $25 for generic CFC inhalers.

To ease the cost, manufacturers of HFAs such as Schering-Plough Corporation, GlaxoSmithKline PLC, Teva Specialty Pharmaceuticals LLC and Sepracor Inc. are offering financial assistance programs, giveaways and cost-cutting coupons for people who are financially pressed or lacking prescription drug coverage. For more details, call the Partnership for Prescription Assistance (PPA) at 1-888-477-2669, or visit www.pparx.org.

The PPA links more than 475 private and public programs that offer specific medications with patients who don't have prescription drug coverage as well as individuals who earn $19,000 or less a year and families of three or more who earn $32,000 a year or less annually.

Jessica Endress of Springfield, N.J., whose 12-year-old son Bobby has asthma, has already switched him to an HFA inhaler and says that it's been working well. Endress reports that she hasn't noticed much of a price difference with her prescription plan and says the benefit of saving the environment — whatever the price difference — is "worth it."

Not everyone feels like Endress, however. Karen Kennedy of Claymont, Del., whose 14-year-old son Jimmy uses inhalers for his asthma, says her co-pay has risen exponentially — from $5 for the CFC inhalers to $55 for HFA brands — a spike that has prompted Kennedy to stock up on the CFC inhalers before the ban takes effect next year. (However, doctors advise checking expiration dates on inhalants before using them.)

Those who bristle at the cost of the new inhalers might consider purchasing them at large pharmacies like Wal-Mart that often offer drugs, including nebulizers, at significantly discounted costs. Wal-Mart offers more than 300 generic medications for $4 for each prescription fill or refill (up to a 30-day supply). For more information, go to Wal-Mart's generic drug program site (www.walmart.com/catalog/catalog.gsp?cat=546834).

When will prices drop?

At the moment, Medicare and Medicaid are picking up the costs (coverage varies depending on individual plans and states) of the inhalers, and more private insurers are starting to get on the HFA bandwagon.

"I have not had any [insurers] turn me down in about the last two months," Honsinger says.

And more good news is on the horizon: The patent on HFA inhalers expires in 2010, at which point the lower-priced generic version should hit the market. That should help make everyone breathe a little easier.


http://www.revolutionhealth.com/conditions/asthma/treatments/inhalers-nebulizers/cfc-ban-effects

 

[Shogun]

As an asthmatic I can tell you that Proventil sucks compared to my Albuterol inhaler. Dr. Spector above must not have asthma. I'm going to be stocking up. If you, or a loved one, knows the panic of an asthma attack I suggest you pay attention. I''m not altogether convinced that this isn't a power play to force our market to increase the profitability of Proventil type substitutions since there is no generic alternative AND there is no evidence that CFCs from inhalers have any kind of significant impact on the ozone.

This is a prime example of capitalism failing the consumer by manipulating the availability of one drug to force users to pay for the new non-generic.



CFC ban will double albuterol inhaler market in US
The US Food and Drug Administration's decision to ban the use of chlorofluorocarbon propellants in albuterol metered-dose inhalers (MDIs) from the end of 2008 will effectively mean the market will revert to one of branded rather than generic drugs and more than double in size, according to Datamonitor.

While competition between Sepracor, Key, GSK and IVAX will create some downward pricing of MDIs, from the beginning of 2009, the generic albuterol market will revert back to a branded one. As a consequence, the value of the US inhaled albuterol market is expected to increase from $190 million in 2004 to $400 million by 2009, predicts Datamonitor.
http://www.in-pharmatechnologist.com/news/ng.asp?id=59304-cfc-ban-will

 

[waltky]

Is time in the sun a new weapon against asthma?...

Sunshine vitamin 'may treat asthma'
19 May 2013 - The amount of time asthma patients spend soaking up the sun may have an impact on the illness, researchers have suggested.

A team at King's College London said low levels of vitamin D, which is made by the body in sunlight, was linked to a worsening of symptoms. Its latest research shows the vitamin calms an over-active part of the immune system in asthma. However, treating patients with vitamin D has not yet been tested. People with asthma can find it hard to breathe when their airways become inflamed, swollen and narrowed. Most people are treated with steroids, but the drugs do not work for all.

Sunshine

"We know people with high levels of vitamin D are better able to control their asthma - that connection is quite striking," said researcher Prof Catherine Hawrylowicz. Her group investigated the impact of the vitamin on a chemical in the body, interleukin-17. It is a vital part of the immune system and helps to fight off infections. However, it can cause problems when levels get too high and has been strongly implicated in asthma. In this study, published in the Journal of Allergy and Clinical Immunology, vitamin D was able to lower levels of interleukin-17 when it was added to blood samples taken from 28 patients.

The team is now conducting clinical trials to see if giving the sunshine vitamin to patients could ease their symptoms. They are looking at patients who do not respond to steroids as they produce seven times more interleukin-17 than other patients. Prof Catherine Hawrylowicz told the BBC: "We think that treating people with vitamin D could make steroid-resistant patients respond to steroids or let those who can control their asthma take less steroids." She said a culture of covering up in the sun and using sun cream may have increased asthma rates, but "it is a careful message because too much sun is bad for you".

Malayka Rahman, from the charity Asthma UK, said: "For the majority of people with asthma, current available medicines are an effective way of managing the condition but we know that they don't work for everyone, which is why research into new treatments is vital. "We also know that many people with asthma have concerns about the side effects of their medicines so if vitamin D is shown to reduce the amount of medicines required, this would have an enormous impact on people's quality of life. "We look forward to the results of the clinical trial."

BBC News - Sunshine vitamin 'may treat asthma'

 

[waltky]

Granny says, "Dat's right - an' it'll keep ya 'regular' too...

Dietary Fiber May Prevent Asthma
January 06, 2014 ~ Certain types of dietary fiber may be protective against asthma, a lung disease that until recently was largely unknown in the developing world. Experts note the incidence of asthma is increasing in less developed countries, as people there shift their eating habits away from high-fiber foods in favor of processed ones.

We get two types of dietary fiber from food - insoluble and soluble. Insoluble fiber, from foods like whole grains, cucumbers and broccoli, includes so-called roughage, which helps cleanse the bowel. A new study by researchers in Switzerland suggests that soluble fiber, which comes from fruits and vegetables, and is broken down by microbes in the intestines, may reduce inflammation in the lungs. Benjamin Marsland, an immunologist at the University of Lausanne, says that until recently, asthma was virtually unknown in nations where people eat a lot of soluble fiber. “In some countries, Burkina Faso, for example, dietary fiber intake is very high and there is no development of allergies whereas in westernized countries we have an intake of dietary fiber is low and the allergies have been increasing,” Marsland said.

Gut bacteria break down soluble fiber, which includes pectin from apples, berries and citrus, into short chain fatty acids. Marsland says the fatty acids interact with spongy tissue inside the bones, where protective immune cells are produced, and help quiet immune system overactivity. An overzealous immune reaction can lead to inflammation. To see whether dietary fiber could influence disease development outside the digestive tract, such as asthma, Marsland and colleagues studied two groups of rodents. One group of mice had been fed a diet high in soluble fiber for two weeks while the other group was fed a diet low in pectin. Both groups were then exposed to dust mites, a leading cause of asthma, a condition marked by lung inflammation, narrowing of the airways and wheezing.

A new study finds that soluble fiber, which comes from fruits and vegetables, may reduce inflammation in the lungs.

Marsland says the mice that ate less soluble fiber had strong allergic reactions to the dust, including the presence of inflammatory compounds in the lungs and constricted airways similar to what’s seen in people. The mice that consumed food rich in pectin, according to Marsland, had lower levels of the immune cells that are usually elevated in allergic asthma. “So the mechanism through which diet is helping the lung is the dietary fiber changes the bacteria in our intestinal tract which changes the metabolites in our circulation and this is influencing how our immune cells develop,” he said.

Researchers confirmed their findings by injecting the mice with another short chain fatty acid. Again, there were fewer inflammatory markers among rodents given the compound. An article describing a link between soluble fiber and asthma is published in the journal Nature Medicine.

Dietary Fiber May Prevent Asthma

 

[Delta4Embassy]

Is a really yummy fruit smoothy with tremendous amounts of soluble and dietary fiber at wal-mart in the orange juice section. Bolthouse Farms brands. The blueberry one has the big fiber content. Discovered it a few years back while on an ultra-strict vegan diet (long since abandoned but discovered some new stuff I enjoy.) All natural ingrediants of just the fruits, nothing added no extra sweeteners etc.

 

[waltky]

Allergies could double the risk for chronic migraines in people who also have asthma...

Asthma can make occasional migraines a chronic condition
Nov. 30, 2015 - Researchers believe allergies could double the risk for chronic migraines in people who also have asthma.

People who have occasional migraines and asthma are twice as likely as those without the breathing condition to develop chronic migraine attacks, according to a new study. Researchers at the University of Cincinnati and Montefiore Headache Center explored the link between migraines and asthma because they are similarly caused by inflammation, either of the blood vessels or airways. They theorize that if one is not directly caused by the other, they may be caused by the same allergens, suggesting allergies in some patients be treated more aggressively.

About 12 percent of the U.S. population gets migraine headaches, which are three times more common in women than men.​

About 12 percent of the U.S. population gets migraine headaches, which are about three times more common in women than men, according to the National Institute for Neurological Disorders and Stroke. People with chronic migraine get headaches 15 or more days per month. The Centers for Disease Control and Prevention reports about 7 percent of American adults have asthma. "If you have asthma along with episodic or occasional migraine, then your headaches are more likely to evolve into a more disabling form known as chronic migraine," Dr. Vincent Martin, a professor of medicine at the University of Cincinnati, said in a press release. "The strength of the relationship is robust -- asthma was a stronger predictor of chronic migraine than depression, which other studies have found to be one of the most potent conditions associated with the future development of chronic migraine."

Researchers analyzed data on 4,446 people with a mean age of 50.4 years, with 80.8 percent of participants being women. The participants were split into two groups, people with asthma and people without it, and completed surveys in 2008 and 2009. The researchers asked about episodic migraines, frequency of headaches, medication usage, depression and smoking status. In the first survey, 17 percent of participants reported having asthma. Overall, 2.9 percent of people who completed the 2008 survey reported they developed chronic migraine by the 2009 survey. Of these participants, 5.4 percent had asthma in 2008, versus 2.5 percent who did not have it.

Previous studies have shown people with asthma are more likely to have allergies, and people with allergies are more likely to have headaches, researchers said. An overactive parasympathetic nervous system may contribute to the potential of developing one or both conditions, which they said is also a reaction to allergens in the environment. "If allergies are the trigger it begs the question: Should we treat allergies more aggressively in these patients?" Martin said. The study is published in the journal Headache.

Asthma can make occasional migraines a chronic condition

See also:

Serious PMS may be early sign of high blood pressure
Nov. 28, 2015 -- Researchers have discovered a link between symptoms of premenstrual syndrome and high blood pressure among women.

According to a study published in the American Journal of Epidemiology this week, women with PMS symptoms may develop hypertension later in life. While following roughly 3,500 women over the course of two decades, researchers associated with the University of Massachusetts found those who experienced PMS were 40 percent more likely to develop hypertension later in life.

A new study suggests women who experience PMS symptoms may experience hypertension -- or high blood pressure -- later in life.​

Symptoms of PMS include, but are not limited to mood swings, abdominal pain, breast tenderness, headaches and bloating. Previously known risk factors for hypertension include high body mass index, smoking, drinking and age. "To my knowledge, this is the first large, long-term study to suggest that PMS may be related to risk of chronic health conditions in later life," lead author Elizatbeth Bertone-Johnson said in a press release.

Females younger than 40 who experienced PMS were found to be more closely linked to eventual high blood pressure, the report said. However, women who consumed high amounts of thiamine and riboflavin -- B vitamins -- were less likely to receive hypertension diagnoses.

Serious PMS may be early sign of high blood pressure

Related:

Study: Added progesterone no help to pregnant women with miscarriage history
Nov. 26, 2015 -- Progesterone supplements given to pregnant women who have had multiple miscarriages may not prevent another miscarriage, according to new research from the University of Birmingham.

A five-year study of 826 women with unexplained recurrent miscarriages showed those who received progesterone supplements in early pregnancy were no less likely to miscarry than those who received a placebo. The findings, published in The New England Journal of Medicine, said the same was true no matter what age, ethnicity, medical history or pregnancy history. Progesterone supplements have been used for more than 60 years to prevent miscarriages in early pregnancy. The study found 65.8 percent of women given progesterone gave birth to a baby compared to 63.3 percent who did not take the supplement.

Progesterone supplements given to pregnant women who have had multiple miscarriages may not prevent another miscarriage, a new study found.​

Professor Arri Coomarasamy, lead author of the study, acknowledged the findings may be difficult for some to accept because of the long-standing notion progesterone will help support a pregnancy. "We had hoped, like many people, that this research would confirm progesterone as an effective treatment," she said. "Though disappointing, it does address a question that has remained unanswered since progesterone was first proposed as a treatment back in 1953. Fortunately, there are a number of other positives that we can take from the trial as a whole."

The study is being lauded as the first well-designed test of the topic. Women participated in the trial at 36 locations in Britain and nine in the Netherlands. Neither the doctors nor the patients knew whether they were receiving the supplements, in the form of vaginal suppositories, or not. The study also found added progesterone does not cause harm to the baby or mother and it may have other uses "such as preventing miscarriage in women with early pregnancy bleeding, so it's not the end of the road," Coomarasamy said.

Study: Added progesterone no help to pregnant women with miscarriage history