HFA inhaler complaints

[poresofkohn]

Hello,
I'm a registered respiratory therapist and I've been reading quite a bit about Pt complaints regarding the "new" HFA albuterol inhalers, specifically that they don't work. Given the usual anxiety component to chronic lung disease I'm not surprised to hear about some people complaining. However, this seems to be quite a movement, there is a group of Pt / consumers trying to start a petition to get the FDA to reinstate the CFC inhalers. It doesn't look like the feds are going to budge. I tend to think this is a case of poorly controlled asthma / rescue inhaler overuse, incorrect user technique, and a more efficient delivery device that Pt's don't "feel" in their mouth / UAW. The only complaint I've heard is "it tastes funny", so I'm wondering if any of you guys on the retail side of things have gotten any complaints. Also, are you able to teach the Pt proper MDI / spacer use? And for the hospital, which inhaler are you dispensing for vented Pt's?
>
Thanks!
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http://www.consumeraffairs.com/health/hfa_inhalers.html
After reading some of these complaints, it's obvious some of these people do not use their inhalers correctly.

 

[MountainPharmD]

Every now and then. Mostly they complain about the price. The old generic CFC inhaler was about 14 bucks. The new HFA is $34.00 and up.

I have had a few people say it doesn't spray the albuterol as forcefully as the CFC inhaler therefore it must not work as well.

People need something to complain about.

 

[WVUPharm2007]

I'm in the minority. I think that the new non-cfc propulsion systems actually works better in my personal use. It seems to make a finer aerosol...thus covering more surface area. I think because the mist is so damn fine, it's undetectable...and people freak out. One puff from the new HFAs seems to do me.

Personally, I just think the public is crazy.

 

[Priapism321]

I'm in the minority. I think that the new non-cfc propulsion systems actually works better in my personal use. It seems to make a finer aerosol...thus covering more surface area. I think because the mist is so damn fine, it's undetectable...and people freak out. One puff from the new HFAs seems to do me.

Personally, I just think the public is crazy.

If by crazy you mean utterly stupid, I concur.

 

[poresofkohn]

People need something to complain about.

Personally, I just think the public is crazy.

If by crazy you mean utterly stupid, I concur.

>
Heheh, that just goes without saying.

 

[poresofkohn]

I'm in the minority. I think that the new non-cfc propulsion systems actually works better in my personal use. It seems to make a finer aerosol...thus covering more surface area. I think because the mist is so damn fine, it's undetectable...and people freak out. One puff from the new HFAs seems to do me.

Personally, I just think the public is crazy.

>
I agree, I've used both and I find that the HFA is more effective, but I know my technique is correct. What are you using for vented Pt's?

 

[njac]

Mostly use nebs for vented patients.

My old hospital used ventolin inhalers. New place does common canister policy.

 

[WVUPharm2007]

>
I agree, I've used both and I find that the HFA is more effective, but I know my technique is correct. What are you using for vented Pt's?

In the hospital, we use nebulized aerosols on patients that are on a vent...

 

[Priapism321]

In the hospital, we use nebulized aerosols on patients that are on a vent...

Obviously the much more safe and effective levalbuterol....

 

[poresofkohn]

Obviously the much more safe and effective levalbuterol....

>
Hoaxenex...LOL!

 

[poresofkohn]

In the hospital, we use nebulized aerosols on patients that are on a vent...

>
Our policy states we use MDI's inline in order to reduce VAP occurrence, however disconnecting the vent circuit for various other reasons than setting up a neb seems to be perfectly acceptable.

 

[kismet]

I have had a few people say it doesn't spray the albuterol as forcefully as the CFC inhaler therefore it must not work as well.

People need something to complain about.

We had a patient in my hospital last week who was afraid we threw out her albuterol inhaler that she brought in on admission and insisted that we must use hers because ours don't work. RT spoke with night pharmacy (off-site) and they confirmed the difference was in propellants. Got an email from my boss asking if we had the patient's meds and I found them, but sat there wondering how her inhaler is different than ours when they are all HFA now.

Turns out the patient's inhaler expired in 2006. (Even better, RT had been administering it for days without pharmacy/physician approval.)

I'm not sure if it's really "okay" for us to give someone expired drugs knowing full well they're going to take them home and use them, but bossman said it's patient's property so we had to give it back upon discharge. Like MountainPharmD said, since the HFAs aren't as forceful, people think it "doesn't work".

 

[poresofkohn]

We had a patient in my hospital last week who was afraid we threw out her albuterol inhaler that she brought in on admission and insisted that we must use hers because ours don't work. RT spoke with night pharmacy (off-site) and they confirmed the difference was in propellants. Got an email from my boss asking if we had the patient's meds and I found them, but sat there wondering how her inhaler is different than ours when they are all HFA now.

Turns out the patient's inhaler expired in 2006. (Even better, RT had been administering it for days without pharmacy/physician approval.)

I'm not sure if it's really "okay" for us to give someone expired drugs knowing full well they're going to take them home and use them, but bossman said it's patient's property so we had to give it back upon discharge. Like MountainPharmD said, since the HFAs aren't as forceful, people think it "doesn't work".

>
I've had several similar experiences, except the Pt didn't want to pay for a new inhaler and brought an expired one from home. In my hospital inhaled medications from home may be approved for use by RT as well as doc / pharmacy. I threw out the inhaler and the Pt FREAKED OUT and I was reprimanded. Twice since then I've had a pt bring an expired inhaler, I refuse to approve it and administer it anyhow. And then I document the crap out of it.

 

[aboveliquidice]

Hello,
I'm a registered respiratory therapist and I've been reading quite a bit about Pt complaints regarding the "new" HFA albuterol inhalers, specifically that they don't work. Given the usual anxiety component to chronic lung disease I'm not surprised to hear about some people complaining. However, this seems to be quite a movement, there is a group of Pt / consumers trying to start a petition to get the FDA to reinstate the CFC inhalers. It doesn't look like the feds are going to budge. I tend to think this is a case of poorly controlled asthma / rescue inhaler overuse, incorrect user technique, and a more efficient delivery device that Pt's don't "feel" in their mouth / UAW. The only complaint I've heard is "it tastes funny", so I'm wondering if any of you guys on the retail side of things have gotten any complaints. Also, are you able to teach the Pt proper MDI / spacer use? And for the hospital, which inhaler are you dispensing for vented Pt's?
>
Thanks!
>
>
http://www.consumeraffairs.com/health/hfa_inhalers.html
After reading some of these complaints, it's obvious some of these people do not use their inhalers correctly.

HFA - Has a less forceful, less cool spray. The taste is also less terrible. Under the usual consumer mentality, this means it does not work as well.

In reality - it was a poorly handled transition. Do you remember the Digital TV switch. After nearly two years of prep, one delay, millions in advertising and coupons, people were still unprepared for the switch. The switch from CFCs to HFA was not nearly as welled prepared for. You can imagine what this does to the consumer.

Explain to your patient's the reality of the situation. HFA is here to stay, CFCs have gone the way of the dodo. The sooner your patients accept that fact, the sooner they can move on.

 

[Pharmavixen]

I'm asthmatic, and like liquidice said, the new salbutamol tastes different.

In the jail we stopped using salbutamol and fluticasone and switched to Symbicort because it's bid, and our boys were using the actuator as a crack pipe. (I use Symbicort myself: way, way better.) Talk about whining! Lawyers phoning, inmates threatening to have fatal asthma attacks and then suing our asses off, etc.

The thing about salbutamol/albuterol is its abuse potential: being sympathomimetic, it gives people a bit of a high (last time I used Ventolin at 8 pm, I couldn't sleep til after 4 am). So you're going to get all sorts of grief over any change.

And even if there's no abuse potential, change is hard.

Edited to add: I've been very successful in teaching proper inhaler techniques. But some people will arrogantly insist they don't need your help before they use their inhaler like a breath spray, holding the canister upside down.

 

[type b pharmD]

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Hoaxenex...LOL!

nice way of putting it !