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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Inhalers and the Environment

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With the enduring premise that there will not be wilderness medicine with the wilderness, it is gratifying to note that it has been approximately 6 months now since the Food and Drug Administration (FDA) advised patients to switch to hydrofluoroalkane (HFA)-propelled albuterol inhalers. Chlorofluorocarbon (CFC)-propelled inhalers, which release chemicals harmful to the environment, will be prohibited for sale in the U.S. after December 31, 2008.

The specific problem with the CFC-propelled inhalers is that they are felt to contribute to depletion of the stratospheric ozone layer, which would increase the potential for harmful ultraviolet radiation to reach the earth's surface. Among other problems, this might lead to increases in skin cancer and cataracts, and might contribute to global warming.

The phaseout of CFC-propelled inhalers is the result of the Clean Air Act and an international environmental treaty, the Montreal Protocol on Substances that Deplete the Ozone Layer. Under this treaty, the U.S. agreed to phase out production and importation of ozone depleting substances, including CFCs.

There are three HFA-propelled albuterol inhalers that have been approved by the FDA: Proair HFA Inhalation Aerosol (Ivax), Proventil HFA Inhalation Aerosol (Schering-Plough), and Ventolin HFA Inhalation Aerosol (GlaxoSmithKline). There is an HFA-propelled inhaler containing levalbuterol, a medicine similar to albuterol, available as Xopenex HFA Inhalation Aerosol (Sepracor).

Albuterol inhalers are often the mainstay of therapy used to treat bronchospasm (airway swelling and constriction that causes wheezing) in persons with asthma and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. Patients use albuterol inhalers to deliver medicine directly into the lungs, which is usually a much more effective method of drug delivery in these situations than is oral administration.

HFA-propelled albuterol inhalers may taste and feel different than the CFC-propelled albuterol inhalers. The spray of an HFA-propelled albuterol inhaler may feel softer (less forceful) than that of a CFC-propelled albuterol inhaler. Patients must also be certain to prime and clean HFA-propelled albuterol inhalers. Doing so prevents buildup of the drug in the inhalation device, which could block the medicine from reaching the lungs. Each HFA-propelled albuterol inhaler has different priming, cleaning, and drying instructions, so patients are wise to read and understand the instructions for their particular device before first using the inhaler.

The CFCs released from albuterol inhalers into the atmosphere represent a "drop in the bucket." According to an article that appears at the conservation oriented website "Mother Earth News," air conditioners and other cooling devices account for the majority of CFC release into the atmosphere. The article reviews where CFCs are used around the home and business and describes some of the alternatives currently available or under development. We clearly have a long way to go, but at least the FDA and pharmaceutical industry have taken a step in the right direction.

Preview the 17th Annual WMS Winter Meeting, "Wilderness & Mountain Medicine," which will be held at The Canyons in Park City, Utah, February 20-25, 2009.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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