ProAir is Full of Hot Air

“I went jogging up on Mulholland. In the middle of my run I had some form of asthma attack and couldn’t even walk. I couldn’t get a ride one block to my house. I thought I was going to die.”
Esai Morales

“I’ve got asthma. When I was 17 I forgot to take my medication and was taken to a hospital for almost two weeks. After that I’ve taken better care of my illness.”
Ville Valo

Asthma and the Albuterol Inhaler:
I have suffered with asthma for most of my life. It is not always an easy disease to live with, as referenced in the quotes above. There is nothing scarier than your ability to breath taken away from you. Fortunately, living with asthma has become manageable due to various medications currently out on the market. There are two common types of medications to help relieve the symptoms of asthma. One is a preventative drug, a drug taken daily to prevent symptoms from surfacing. The other is a rescue drug, a drug taken for immediate relief of minor to major symptoms. The most popular way to consume the medication is through an inhaler. Inhalers propel the medication directly into the lungs, offering instant relief. Moreover, inhalers are small and portable, making it easy for people to have the drug with them at all times.

Perhaps the most common inhaler used today is Albuterol. Albuterol works by relaxing the muscle tissues and dilate the airways. Originally approved by the FDA in 1981, it has been sold in the form of many different brand names: Proventil, Ventolin, Volmax among others. However, Albuterol had gained popularity as a generic drug as the price per inhaler ranged from only $5.00 – $10.00 depending on coverage. Unfortunately, as of December 2008 Abuterol inhaler can no longer be purchased in it’s generic form. The FDA has completely banned the Albuterol inhaler because its propellant is linked to damaging the ozone layer.

In the inhaler form, the Albuterol drug is propelled through the use of chlorofluorocarbon or CFC. Chlorofluorocarbon has been dropped from most products across all industries 25 years ago. Countries worldwide signed an international treaty called “The Montreal Protocol on Substances That Deplete the Ozone Layer” which called for banning CFC propellants. The US ended production and importation of CFCs for all commercial applications in 1996, but because there was no alternative for the asthma inhaler Albuterol, they were allowed to stay on the market until December 2008.

The Albuterol Replacement – ProAir HFC:
The new alternative to the Albuterol inhaler is a hydrofluoroalkane (HFA) propelled inhaler. In 2004 Teva Pharmaceuticals released their version of the Albuterol inhaler called ProAir HFA (Other brands were release including Proventil HFA and Ventolin HFA). Their new inhaler was now environmentally friendly and ready for the public as Albuterol was taken off the shelves in late 2008. Unfortunately, this replacement has not been looked upon too kindly by asthma suffers, myself included.

When I first purchased ProAir, I noticed two things: One, the drug is no longer generic meaning I paid $25.00 instead of my usual $10.00. Second, the inhaler was half the size of my Albuterol inhaler; so I am paying 150% more for half my medication.The disappointment didn’t end there… When I used my ProAir, it tasted awful. I’m used to the flavor now, but I still don’t care for it. Furthermore, the inhaler clogs up with time. After a couple of months, the inhaler will get clogged by the residue of the medication. The best way to remedy this is to clean the inhaler after every use. However, I opt for the lazy approach by grabbing a needle or a knife, and opening a crater to let the medication flow properly. I don’t recommend this because I can just see every doctor shaking their head at me as they read my alternative.

My first impressions of ProAir was that it was a complete scam – Ban a generic drug millions of people use to push a brand drug and generate more revenue. Use the excuse of the old drug being bad for the ozone layer, and the drug companies have the perfect window dressing to sell their inferior product to the masses.

With careful study though, I found out that CFC had been banned for some time. A pharmacist at Sav-On told me he saw this coming a long time ago, and warned people about it. I don’t have as much of a problem now with the banning of CFC inhalers (even though it’s scientifically improbable that an inhaler would contribute to the destruction of the ozone layer; just as it is equally improbable that O3 emitted from a power drill would improve the ozone layer) as there was a treaty signed, and I believe we should always live up to any commitments we make. However, my problem with the banning of Albuterol is the execution of how it was done. The FDA could have waited until HFC inhalers became generic before removing Albuterol. The fact that they did not wait, really makes their hands look dirty in the process. People depend on this medication with their lives, and for the FDA to remove Albuterol when there was not an equivalent product at the same price, is irresponsible and completely unethical.

I don’t have any doubts that the FDA and the drug companies financially benefited from prematurely removing Albuterol before there was a generic equivalent. There is no other logical reason to do so as HFC inhalers have been on the market since 2005. In the mean time, we the asthma sufferers are the ones that have to pay more to keep ourselves alive.

The good news is that ProAir HFC should be going generic in late 2009/early 2010. Unfortunately, it only remedies one of the problems with the product, all be it the largest problem. ProAir is still one of the worst inhalers I have ever used. I’m sure there will be improvements made in good time, as this is too big of a market to ever ignore. Until then, we can at least breath a little easier (cheesy pun alert) now that we will no longer have to pay a premium price for a substandard product.

A Strategy for Asthma:
This may seem a little off topic, but I felt I should add my personal experience with asthma, and what I am currently doing to depend less on prescription drugs. I like to think of asthma as more of an allergy than a disease (although technically I think it’s both). The best strategy against an allergy is to avoid the substance that causes the allergy. Likewise with asthma, one must be able to identify what is triggering the symptoms. Is it a dog? Dust? Little small rabbits? When you identify each and every substance that triggers your asthma, you will know what to avoid in order to keep you from experiencing symptoms.

Medications are also a necessary arsenal against asthma. Advair from Glaxo Smith Kline, is an amazing drug that I used to take once a day to help prevent symptoms of asthma. I never had any side effects, and the medication was truly a miracle. On Advair, I would rarely suffer any asthma symptoms. I used to think of it as the cure for asthma. The problem is that I became completely dependent on the drug – i.e. if I didn’t take the drug, I would experience asthma symptoms. I don’t like to depend on drugs in order to stay alive, so I began to cut back my Advair intake; instead of once a day, I took Advair once every other day. This seemed to work well until I lost my job, and with it, my health insurance that covered brand name drugs.

Amazing things occur in the most unusual circumstances. After I lost my job, I started helping my friend at his restaurant. He needed help in the kitchen, so I began to learn how to cook. Every day I was in the kitchen cooking wonderful Italian dishes. I wouldn’t get out of work until late in the evening, and by that time, I had forgotten to take my Advair. For some reason, I wasn’t experiencing any asthma symptoms any time I worked in the kitchen. Something odd was happening. Every time I worked in the kitchen, I could breath incredibly well. That little Italian kitchen was an asthmatic paradise. My wife logically deduced that garlic was the only substance that could cause such a reaction, as it is heavily used in every dish in the restaurant. This revelation could not come at a better time, as my last Advair inhaler was about to run out. I purchased garlic supplement pills at my local drug store and began taking them every day. I am happy to say that I have been Advair free since April. What is it about the garlic that helped prevent the symptoms of asthma? Unfortunately, I cannot find an answer to this question. I’ve read that garlic has cardiovascular benefits, but I can’t find any scientific data. All I can do is report my findings. Hopefully my story will help other asthma sufferers come up with the best way to treat their asthma.

- The Crumb

Score for ProAir HFA:

Rating:  

Special thanks to Dr. Sharon Orrange for helping me with some information on this article. Dr. Orrange is an Internal Medicine Doctor and an Assistant Professor of Medicine at the University of Southern California. She is also a contributor for DailyStrength.org. You can read her articles here: http://www.dailystrength.org/blog?user_id=134&surface=archive

1. 

   Naiad says:

   October 5, 2009 at 12:31 pm

   Great review Mr.Crumb. I dealt with an asthmatic child for years, and I know how hard it could be to manage the disease, the costs involved, the frustration, etc.

   [Reply]