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What Every Asthma Patient Needs to Know About the New HFA Inhalers

Ann Marie Harper, PharmD Candidate 2009

Bernard J Dunn School of Pharmacy, Shenandoah University

Prepared during Consumer Health Information Corporation Clerkship


Dorothy L. Smith, Pharm.D.

CEO and President

Consumer Health Information Corporation

McLean, Virginia



“I’ve had asthma for years and was getting along very well with the assistance of a CFC inhaler.
One day I went to the drug store to pick up a new prescription for a CFC inhaler and noticed it
said HFA instead of CFC.  I thought maybe the name changed so I went ahead and tried it.
What a shock I had!  First of all, it was a much smaller inhaler. Then, the taste was HORRIBLE!
But that was just the beginning for me…
(from Nancy of North Carolina)


If you are confused about what “CFC” and “HFA” mean and why some inhalers are now different, you are not alone. People with asthma are now faced with change. Beginning January 2009, the
FDA stated that inhalers should no longer contain chlorofluorocarbons (CFCs) in an effort to comply with the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer. CFCs erode the ozone layer by affecting the stratosphere that protects us from the suns harmful ultraviolet (UV) rays.  Normally, the stratosphere soaks up UV rays and keeps them from reaching earth’s surface. When
the stratosphere is damaged, UV rays can reach the earth’s surface and increase the risk of developing skin cancer and cataracts.    

New inhalers contain a propellant called hydrofluoroalkane (HFA) which does not affect the ozone layer. A propellant is an ingredient which moves medicine out of the inhaler so you can breathe the medicine into your lungs. The new propellant can be found in products that contain the medicine albuterol or a form of albuterol called levoalbuterol. The old CFC inhalers and the new HFA inhalers still contain the same medicine. The only difference between them is the propellant that pushes the medicine out of the inhaler. 

What Patients are Saying


While the medicine is the same, some patients have noticed differences between the old CFC inhalers and the new HFA inhalers.  Some of the differences include:

  • HFA inhalers have a different taste and feel than the old CFC inhalers.
  • The new HFA inhalers have a warm, softer spray coming from the inhaler. Some patients are worried that the inhaler is not working or that the dose of medicine will not work because of the softer spray.


To make sure the medicine is working, it is important to remember these steps:

Take a slow, deep breath.

  • You must breathe in more SLOWLY when using an HFA inhaler. This helps make sure the full dose of medicine gets into the lungs to open your airway.   

Prime the HFA inhaler before you use it.


When you prime an inhaler, you are making sure the medicine sprays from the inhaler correctly so you can breathe it into the lungs. If you do not prime the inhaler properly, you will not get an accurate dose.  In general, an HFA inhaler should be primed before you use it for the first time or if you have not used it for more than 14 days. 

The correct way to prime your Ventolin (albuterol) HFA inhaler is as follows:

  • Take the cap off the mouthpiece. 
  • Shake the inhaler well to make sure the medicine mixes with the propellant.
  • Spray a puff of medicine into the air away from your face. 
  • Shake and spray the inhaler like this three more times to finish priming it.

Each inhaler has different priming instructions. Before using a new inhaler, look at the inhaler instructions or talk to your pharmacist. 

Clean the HFA inhaler once a week.

This is an important step because the medicine inside the metal canister is sticky and can clog the mouthpiece. Clogging will decrease the amount of medicine each puff delivers and you will not get
an accurate dose.

  • Remove the metal canister from the mouthpiece.
  • Place the mouthpiece and cap under warm running water for 30 seconds.
  • Allow all parts of the inhaler to dry completely before putting the metal canister back
    into the mouthpiece.

Ways to avoid paying too much for your inhaler.

Cost has been another worry for patients switching to HFA inhalers.  Most of the old CFC inhalers were available in generic form and had a cheaper copay.  Unfortunately, new HFA inhalers are not available in generic form yet and may cost more.   

If cost is an issue,  there are some options for getting these HFA inhalers at no cost or a lower cost. 


Currently, some manufacturers are offering online coupons that can be taken to your pharmacy and used on your next inhaler purchase.

        ProAir HFA: www.proairhfa.com

        Internet Drug Coupon database:  http://www.internetdrugcoupons.com/Proairhfa-Coupon. 

        Ventolin HFA: http://www.ventolin.com/coupon_special_offers.jsp

        Internet Drug Coupon database: http://www.internetdrugcoupons.com/Ventolin-Coupon

Partnership for Prescription Assistance

        Website: https://www.pparx.org/Intro.php, Contact phone number: 1-888-477-2669.

This organization works with drug companies, healthcare providers, patient advocacy organizations and other community groups to help patients who do not have prescription drug coverage get the medicines they need. They find private or public programs that look for ways to get free or nearly free medicines for patients.

Those are just some of the ways you can save money on your HFA inhaler. Be on the lookout for other cost-saving offers that may appear in your local newspaper or your favorite magazine. 

Conclusions and Recommendations

New HFA inhalers have a different taste, the spray feels different and they cost more. However, research has shown that HFA inhalers are just as effective at helping patient’s breathe during an asthma attack. New HFA inhalers contain the same medicine, albuterol or levoalbuterol, as the CFC inhalers. The only difference is the propellant.

When using your new HFA inhaler, remember the patient information tips provided in this article. These tips will help make the switch from your old inhaler to your new HFA inhaler easier. If you need more information, your pharmacist will be able to answer your questions and can help you use your inhaler more effectively. 


© 2009 Consumer Health Information Corporation. All rights reserved.