The importance of preserving choice in inhalation therapy: the CFC transition and beyond

Inhaled therapy is a mainstay of asthma and chronic obstructive pulmonary disease (COPD) treatment. Metered dose inhalers (MDIs) using chlorofluorocarbon (CFC) propellants are currently the most widely used type of inhaler in the world. In 1987, the Montreal Protocol precipitated the change from CFC technologies to ozone-friendly alternatives, a process which is curently under way and requires the transition of millions of patients to new drug delivery systems, primarily MDIs using hydrofluorocarbons (HFCs). However, HFCs have been identified as greenhouse gases and are now being evaluated under a separate global climate change treaty (the Kyoto Protocol).
Against this unique background, this paper looks at the role of inhalation therapy in the treatment of lung disease and examines the factors which influence both primary care prescribers and patients in their choice of the most appropriate drug/device combination. It is important that switching therapy for non-therapeutic reasons does not constrain this choice.
Very little information on the effects of the CFC transition on patients and physicians is yet available. Given how important it is for effective treatment that a choice of inhaler device is maintained, the experience of the current transition should be more fully evaluated as a context for futher environmental policy measures. Any measures that could affect patient use of HFC-MDIs should be carefully considered by all stakeholders, especially if these are imposed while the transition of patients from CFC-MDIs is still in progress.