Moving from CFC Aerosol to HFA Aerosol or Dry Powder Inhalers: What Do Patients Think?

Abstract

Background/Objectives: Environmentally friendly hydrofluoroalkane (HFA) pressurised metered-dose inhalers are currently being marketed to replace chlorofluorocarbon (CFC)-driven devices. It is uncertain whether these new formulations with different properties are acceptable to patients. Similarly, switching a patient to a dry powder inhaler (DPI) carries the risk of non-acceptance. Methods: One hundred patients with obstructive airway disease on regular CFC aerosol inhaler medication underwent a standardised, structured interview. During the interview patients were asked to use a new HFA aerosol inhaler and three DPIs in random order. Patients’ notions were recorded. Results: Most patients (96) agreed to change from their CFC to the HFA inhaler, of those, only 12 did so with some reservation. Properties (taste, user-friendliness, design) of the HFA inhaler were rated favourably. DPIs represented an acceptable alternative to aerosol inhalers. In fact, 57 patients preferred a DPI over the HFA inhaler. Not all powder devices were equally acceptable. Replacing the CFC inhaler with patients’ preferred alternative devices resulted in a more than 3-fold increase in costs. Conclusion: Concerns about the acceptability of reformulated CFC-free aerosol inhalers are ill founded. However, if given the choice, many patients prefer a DPI over the HFA inhaler. The transition offers an opportunity to review patients’ current treatment and the proficiency of their inhaling technique. Moving to CFC-free inhalers will have revenue implications.

Beclomethasone/formoterol fixed combination for the management of asthma: patient considerations

“…Moreover, because the drug is dissolved in the propellant, solutions can be tailored to extrafi ne drug delivery, reducing the particle size of emitted aerosol and thereby allowing deeper penetration in the bronchial tree. Switching from a CFC pMDI to an HFA pMDI was well accepted by most patients in one study (Hartung et al 2002): the taste was described as good and sweet, and the softer and slower jet was appreciated.…”

“…In recent decades, possible adverse effects on health and the environment as a result of the destruction of the earth's ozone layer by CFC paved the way for the ban of these compounds under the Montreal Protocol (Hartung et al 2002;Newman, 1990). New propellants without ozone-damaging properties -hydrofl uoroalkanes (HFA) -have been developed, and reformulated, environmentally friendly inhalers have been shown to be nontoxic, safe, and effective.…”

Double-Blind, Double-Dummy, Multinational, Multicenter, Parallel-Group Design Clinical Trial of Clinical Non-Inferiority of Formoterol 12 μg/Unit Dose in a b.i.d. Regimen Administered via an HFA-Propellant-pMDI or a Dry Powder Inhaler in a 12-Week Treatment Period of Moderate to Severe Stable Persistent Asthma in Adult Patients

“…This, combined with the possibility of fl ow resistance due to moisture within the device [13] , indicates that DPIs may not always be suitable alternatives to pMDIs. Further, consideration should be given to the risk of non-acceptance leading to non-compliance when patients are switched from pMDIs to DPIs as noted by Hartung et al [14] who found that not all powder devices were equally acceptable to patient These factors have led some experts to recommend that, during the transition from old inhalers to new, patients currently using a CFC pMDI should be switched to a CFC-free pMDI rather than a DPI, the latter only being considered if clinically indicated [13] . Modulite ® (Chiesi Farmaceutici S.p.A.) is a new type of pMDI that has been developed in response to the Montreal Protocol.…”

The paucity of ethical analysis in allergology

“…But these cumulative innovations have not been exclusively beneficial. The patenting of these novel drug administration methods has resulted in pharmaceutical companies regaining monopoly rights in the production of once common, and inexpensive, generic asthma drugs [103]. Such monopoly privileges restrict access and impose cost-barriers [104,105] to medications that many impoverished people require to live free of severe disability (elevated costs of treatment are also a major factor in patient non-compliance to therapy [106]).…”