A nationwide shortage of inhalers – used by many of the 10 million Americans, including nearly 400,000 Coloradans, with asthma – is driving up prices and could force doctors to consider alternate treatments.
“Already I can’t get them,” said Virgil Miller, of Denver’s Capitol Heights Pharmacy. “I have enough probably for the month of February, but after that, I don’t know.”
Miller said his local distributor had none, so he has placed an order with a New York company. On that order, the price for each inhaler jumped from $2.84 to $8.40, he said.
The shortage is being linked to a change in the propellant that delivers the medication in the inhalers. Chlorofluorocarbons, or CFCs, which damage Earth’s protective ozone layer, are being phased out.
All CFC-propelled inhalers must be off the market by Dec. 31, 2008, the federal Environmental Protection Agency has ruled.
New inhalers are being made with hydrofluoroalkane but are not yet widely available in the United States.
“There appears to be a flub in transition from the old (inhalers) to the new, and there are not enough of both,” said Dr. Kerstin Floyd, pharmaceutical liaison for Kaiser Permanente in Colorado.
Physicians certainly ought to be alerted to the shortage, said Dr. Norman Edelman, chief medical officer of the American Lung Association.
“There are a lot of people just using the quick relievers now. If those are not available, that could be a very serious problem,” Edelman said.
It’s a problem that might force physicians to change how they prescribe asthma medications, Edelman said.
In a letter obtained by The Denver Post, AmerisourceBergen, a Pennsylvania-based distributor of medical products, told pharmacists that the inhalers are being allocated as “demand continues to outpace supply.”
Amerisource spokesman Michael Kilpatric said that means pharmacies receive inhalers “based on their normal volume.”
The letter, signed by Amerisource vice president Brian Jones, warns that supply of the inhalers will be “short at best in the months ahead.”
Schering-Plough Corp., parent of one of three inhaler makers, is manufacturing them at full capacity, said spokeswoman Julie Lux.
“We have also engaged in a self-imposed allocation program” with wholesalers, she said, and have asked them to do the same “to assure a constant supply.”
“There are other manufacturers, from what we have heard, that have had a decrease in production,” Lux said.
The production shortage affects the drugs physicians call short-acting beta-agonists. Patients call them rescue inhalers, Kaiser’s Floyd said.
She said the inhalers, which deliver doses of drugs, quickly open airways when an asthma patient has an acute attack.
Most asthma patients rely on other drugs for routine control of their disease, using inhalers in emergencies or acute attacks, doctors say.
Patients can use nebulizers in place of the inhalers, but those are less portable, said Dr. E. Rand Sutherland, a pulmonologist at National Jewish Medical and Research Center.
“What I’m hoping we don’t see is patients being unable to do things outside or travel,” Sutherland said.
Lisa Phillips, whose son and daughter have what she called “pre-asthma” that periodically causes breathing problems, said she is not overly concerned.
“I don’t see any need for worry,” she said. “It is something people need to be aware of, though.”
Floyd said one inhaler should last an asthma patient about a month. Emphysema patients, some of whom also rely on the inhalers, probably use more than one a month, she said.
Nationwide, about 10 million people have asthma, including 366,000 Coloradans, according to the local chapter of the American Lung Association.
Staff writer Karen Augé can be reached at 303-820-1733 or kauge@denverpost.com.
