Lots of questions come regularly from our readers about what to do long-term for asthma. The old inhalers used to be active longer and could be stored for at least a few years under ideal conditions and retain their effectiveness. Not anymore. Thanks to our overlords, the current Federal government, inhalers all have by law changed over to the more “green” HFA type delivery system now. In 2008, the Feds in their infinite wisdom (under Bush by the way), decided to comply with the 1987 Montreal Protocol for Substances that Deplete the Ozone Layer which included the CFCs found in our inhalers. Prior to that, the old CFC propellant inhalers were considered to be “medically necessary” and were exempt from the actual international treaty signed by the US in 1989. The HFAs were delevoloped long ago and commercially for inhalers in 1994, but since they were not generic and the actual CFC contribution to the ozone depletion was zero, the CFCs lived on through a couple decades of peace. The actual consulant to the FDA is quoted as saying:
that CFC inhalers release negligible amounts of the propellant and do not pose a threat to ozone depletion; however, in 1987 (1989 actually) the United States and 185 other countries signed the Montreal Protocol, a treaty for the complete withdrawal of all CFC products. CFC inhalers were considered medically necessary until the development of HFA inhalers. (Leslie Hendeles, University of Florida professor of pharmacy and pediatrics and consultant to the FDA)
Quite hilariously, the environmental groups were not happy at the time with HFAs because they contribute to “greenhouse gases” too, but one cow contributes the same amount of “greenhouse gas” in the form of methane as 10 asthmatics per day, so they focused on cow reduction. Wow, hippies sure are entertaining! While cows still seem to run amok polluting the world with their delicious steaks, the HFAs replaced the much more evil CFCs to solve all the worlds’ holy ozone problems. Just because they don’t work as well is no concern to the enviromental masters, for they know better than we ever could.
The real problem is that the new HFA inhalers do not last as long as the old CFC inhalers (only 2 months for Ventolin once opened), they are MUCH more expensive (three times on average), and are not as powerful. No big deal in our constant spending, super-wasteful, refill-monthly society, right? Well, in terms of prepping and being ready for any disaster, it sure does make a difference. So, at best, storing inhalers at optimal conditions will probably last a year at best. What is a prepper with asthma or a concerned parent to do to help make the future safer for themselves or their family? Anyone that saw the absolutely heart-stopping scene in Signs can appreciate the fear of a parent with an asthmatic child looking towards the rocky future that faces us. So, now that we are stuck with HFAs forever, we might as well live in the real world and do the best we can.
The solution of stocking up on the HFA inhalers and “hoping for the best” is not a good one. Luckily, albuterol has been around for a long time and is available in tablet form. While the tablet is slightly slower in delivery than the HFA physiologically, it is stable long term when stored properly. Albuterol tablets are seriously as cheap as dirt and readily available. The 4mg tablet is roughly equivalent to 2 puffs of an inhaler of albuterol, and lasts the same amount of time. 1/2 a tablet is roughly equivalent to 1 puff of the albuterol inhaler. Therefore, it is really simple to transition from puffs to tablets for most patients. The only real reason that doctors don’t prescribe tablets of albuterol is that they don’t have to. Most insurance covers inhalers, and patients that are wheezing or short of breath prefer something delivered via inhaler to a pill. The only time that my prescription pad was used to write for albuterol tablets was when a patient was intolerant to inhalers altogether and therefore the pill was the only option. But, that was the old, non-prepper me.
The dosing needed for most people for the tablets is 2 to 4 mg orally 3 to 4 times a day. This may increase stepwise to a maximum of 8 mg orally 4 times a day. Similar to albuterol inhalers, some people need more than other people to control their symptoms. The interesting thing about the tablets is that the dose will be the same whereas the inhaler dosing will vary by the effectiveness of the inhalation method used by the patient. So, sometimes folks using their inhalers ineffectively will get by with LESS dosing as it is steady rather than variable, but again, this is something that will vary from one patient to another and will also vary day to day with allergen and trigger exposure within the same patient. The key is of course having the medication to use, so start working with your doctor to try and procure the albuterol that you may need now and in the future.
Unfortunately for us all, the barriers to helping folks are high and the future unclear. We here at SH are continuing to work towards being able to do consultations for chronic medical conditions like asthma in the near future, but nothing is yet developing here in our home state. Talk to your doctor about a trial of tablets to have as a back-up and then try them for effectiveness. See if you can then have your doctor prescribe both tablets and inhalers so that both methods are available. Try to refill the tablets often and store effectively for use in the future. When stored properly, a tablet medication like albuterol will be biologically effect for many years after its expiration date, see the “Expiration and Storage” tab on my header for more details. As always, from a legal and common-sense standpoint, any change in medication without consultation with your doctor is NOT recommended and should be done only under the guidance of a physician.
that CFC inhalers release negligible amounts of the propellant and do not pose a threat to ozone depletion; however, in 1987 (1989 actually) the United States and 185 other countries signed the Montreal Protocol, a treaty for the complete withdrawal of all CFC products. CFC inhalers were considered medically necessary until the development of HFA inhalers. (Leslie Hendeles, University of Florida professor of pharmacy and pediatrics and consultant to the FDA)
Quite hilariously, the environmental groups were not happy at the time with HFAs because they contribute to “greenhouse gases” too, but one cow contributes the same amount of “greenhouse gas” in the form of methane as 10 asthmatics per day, so they focused on cow reduction. Wow, hippies sure are entertaining! While cows still seem to run amok polluting the world with their delicious steaks, the HFAs replaced the much more evil CFCs to solve all the worlds’ holy ozone problems. Just because they don’t work as well is no concern to the enviromental masters, for they know better than we ever could.
The real problem is that the new HFA inhalers do not last as long as the old CFC inhalers (only 2 months for Ventolin once opened), they are MUCH more expensive (three times on average), and are not as powerful. No big deal in our constant spending, super-wasteful, refill-monthly society, right? Well, in terms of prepping and being ready for any disaster, it sure does make a difference. So, at best, storing inhalers at optimal conditions will probably last a year at best. What is a prepper with asthma or a concerned parent to do to help make the future safer for themselves or their family? Anyone that saw the absolutely heart-stopping scene in Signs can appreciate the fear of a parent with an asthmatic child looking towards the rocky future that faces us. So, now that we are stuck with HFAs forever, we might as well live in the real world and do the best we can.
The solution of stocking up on the HFA inhalers and “hoping for the best” is not a good one. Luckily, albuterol has been around for a long time and is available in tablet form. While the tablet is slightly slower in delivery than the HFA physiologically, it is stable long term when stored properly. Albuterol tablets are seriously as cheap as dirt and readily available. The 4mg tablet is roughly equivalent to 2 puffs of an inhaler of albuterol, and lasts the same amount of time. 1/2 a tablet is roughly equivalent to 1 puff of the albuterol inhaler. Therefore, it is really simple to transition from puffs to tablets for most patients. The only real reason that doctors don’t prescribe tablets of albuterol is that they don’t have to. Most insurance covers inhalers, and patients that are wheezing or short of breath prefer something delivered via inhaler to a pill. The only time that my prescription pad was used to write for albuterol tablets was when a patient was intolerant to inhalers altogether and therefore the pill was the only option. But, that was the old, non-prepper me.
The dosing needed for most people for the tablets is 2 to 4 mg orally 3 to 4 times a day. This may increase stepwise to a maximum of 8 mg orally 4 times a day. Similar to albuterol inhalers, some people need more than other people to control their symptoms. The interesting thing about the tablets is that the dose will be the same whereas the inhaler dosing will vary by the effectiveness of the inhalation method used by the patient. So, sometimes folks using their inhalers ineffectively will get by with LESS dosing as it is steady rather than variable, but again, this is something that will vary from one patient to another and will also vary day to day with allergen and trigger exposure within the same patient. The key is of course having the medication to use, so start working with your doctor to try and procure the albuterol that you may need now and in the future.
Unfortunately for us all, the barriers to helping folks are high and the future unclear. We here at SH are continuing to work towards being able to do consultations for chronic medical conditions like asthma in the near future, but nothing is yet developing here in our home state. Talk to your doctor about a trial of tablets to have as a back-up and then try them for effectiveness. See if you can then have your doctor prescribe both tablets and inhalers so that both methods are available. Try to refill the tablets often and store effectively for use in the future. When stored properly, a tablet medication like albuterol will be biologically effect for many years after its expiration date, see the “Expiration and Storage” tab on my header for more details. As always, from a legal and common-sense standpoint, any change in medication without consultation with your doctor is NOT recommended and should be done only under the guidance of a physician.
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