 |
CFC-free Transition
Current CFC-free and CFC containing Inhalers
The Montreal Protocol (1987)
Australia is a signatory to the Montreal Protocol (1987) and subsequent adjustments and amendments. The Protocol is an international agreement which requires developed countries to phase out, with some strictly limited exceptions, all production and import of halons by 1994, CFCs by 1996 and methyl bromide by 2005. To comply with the Montreal Protocol, industry has had to develop and implement the use of several interim and long-term replacements for CFCs.
In regard to the use of CFCs in asthma aerosol inhalers, hydrofluoroalkanes (HFAs), sometimes referred to as HFCs (hydrofluorocarbons) are the preferred replacements because they contain neither chlorine nor bromine and therefore have no detrimental effect on stratospheric ozone. The most widely used HFA is HFA-134a, which has only one third of the 'greenhouse' (global warming) effect of the CFCs it replaces. Thus the conversion of industries from CFC use to HFA use has reduced and will reduce both stratospheric ozone depletion and global warming.
CFC Emissions Declining
As a result of global compliance with the Montreal Protocol several years ahead of the mandated schedule, the CFC emissions are declining. However, CFC concentrations in the stratosphere are still increasing because CFCs emitted in earlier years continue to rise to the stratosphere (the most widely used CFCs remain in the atmosphere for between 50-100 years). Scientists predict that ozone depletion will reach its worst point during the next few years and then gradually decline until the ozone layer returns to normal around 2050, assuming that the Montreal Protocol and its adjustment and amendments are fully implemented.
CFCs in Australia
CFC consumption in Australia peaked in the mid-1970s at around 20,000 tonnes per year, largely from the aerosol, refrigeration and foam plastics industries. Adoption of a national strategy, guided by the Montreal Protocol, to protect the ozone layer, has resulted in CFC consumption in Australia dropping dramatically.
Historically, asthma aerosol inhalers have constituted less than 1% of the estimated half a million tonnes of CFCs released by all industries in Australia since their first use in the 1960s.
Current Situation
The first CFC-free inhalers were introduced in February 1999 and most asthma inhalers are now CFC-free. Some products, such as Becotide, Becloforte, Bricanyl Inhaler, Respocort Inhaler, Respocort Autohaler and Pulmicort Inhaler were withdrawn in 2002-3, but there are good alternatives to these. Others still have to change to CFC-free by the end of 2005.
A stickiness problem has been found with some of the new propellants, especially Intal Forte CFC-free and Tilade CFC-free. As a result, these have packs with 2 actuators, one to use while the other is drying after washing. Cleaning instructions for all the new inhalers are included in the Consumer Medication Information in the pack and should be followed closely, as instructions vary.
CFC-free inhalers now available are Airomir, Airomir Autohaler, Asmol, Epaq, Ventolin, Intal Forte CFC-free, Flixotide, Qvar, Qvar Autohaler, Tilade CFC-free, Atrovent and Seretide.
Serevent is available as a CFC-containing inhaler. Atrovent, Becloforte, Becotide, Bricanyl Inhaler, Pulmicort Inhaler Respocort Inhaler and Respocort Autohaler were withdrawn in 2002-3.
Dry powder inhalers continue to be available - Bricanyl Turbuhaler, Flixotide Accuhaler, Flixotide Diskhaler, Pulmicort Turbuhaler, Foradile Aerolizer, Oxis Turbuhaler, Symbicort Turbuhaler, Serevent Accuhaler, Serevent Diskhaler and Seretide Accuhaler. These dry powder inhalers are not affected by this change as they have no propellant.
During this changeover period, it is important to advise patients with asthma to continue taking their prescribed medication. If a patient believes their CFC-free inhaler is not effective, they should speak to their doctor. It is more likely to be worsening asthma than a problem with the inhaler. It is important to read the instructions in the packet for any new inhaler. A few of the CFC-free inhalers have a stickiness problem so it is very important to advise patients on cleaning their inhaler.
The change to CFC-free inhalers is a good opportunity to instigate a review of the patient's asthma management.
Current
CFC-free and CFC containing Inhalers
|
*has a stickiness problem so comes in a pack with 2 holders, important to follow the cleaning instructions.
Dry Powder Inhalers
(Not affected by the CFC issue)
|