New Albuterol HFA Inhalers May Increase Breath Alcohol

In an effort to save the ozone layer, the government has ridiculously mandated the phase out of standard chlorofluorocarbon (CFC) albuterol inhalers, and replaced them with hydrofluoroalkane (HFA).

Yep, in all their wisdom, the feds decided that all those asthmatics puffing away on their albuterol inhalers were creating a larger hole in the ozone layer than a gazillion automobiles or horrendously outdated factories. Don't get me started.

Well, don't puff on that new HFA inhaler within 5 minutes of getting pulled by the police over while you're speeding down the highway in your SUV... turns out that some of the HFA inhalers include ethanol, and it just might transiently raise your breath alcohol (less so than a drink of wine, though). Or so report researchers from Australia in a recent issue of the journal Respirology.

To be honest, if you need to urgently take albuterol, maybe you should just pull over for a while.

So... how long before the Hollywood lawyers start using the "inhaler-defense" at DUI trials?


  1. Thanks for your comment. Some of my patients have also been unhappy with the HFA inhalers. I would not go so far to say that HFA inhalers are causing deaths, though. Although I am not familiar with all the details of the cases described in the articles cited in your post, I think it is fair to say that the no investigation has confirmed HFA rescue inhalers as being responsible for an asthma related death.

    I believe that the main reason that people are unhappy with the HFA inhalers is that they are trying to use them in same way as they used CFC inhalers- this will result in not getting the active medication and only receiving a breath of the inactive component of the propellant.

    HFA inhalers must be shaken well before use. In addition, the HFA inhalers must be primed before use (the numbers of puffs with which to prime and the amount of time withour use before priming is necessary varies with each inhalers, so the onus is on the physician and pharmacist to properly train patients in the use of these inhalers.

    For more information, please see the following document from the Asthma & Allergy Network- Mothers of Asthmatics. This poster describes the differences and instructions for use for the various HFA rescue inhalers currently on the market.

    When used properly, I believe that HFA inhalers do work. The transition will take some getting used to, though. Ask your asthma specialist to work with you to make sure that your rescue medication is working properly- we will be happy to help you make the transition!

  2. Dr Bajowala,

    I want to thank you for posting my comment - I respect your blog and your knowledge as a Doctor. It is troubling to me as an asthma patient to have experienced problems with HFA albuterol and to witness what appears to be an alarmingly high number of complaints from people the nation over. If nothing else, I think this is something to keep an eye on and further studies may be warranted.

    Thanks again and kind regards :-)

  3. The HFA inhalers are 10 times more expensive (since they are not available in generic) and 10 times less effective. I now use a time-wasting nebulizer in order to get the same relief that the CFC inhalers provided with two puffs.

    But the alcohol-breath problem occurred with the CFC inhalers as well. Pulling over to take one's medicine is no help, since one can be arrested for being DUI if one is simply in a vehicle; he/she doesn't need to be driving!


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