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7 May 2010
Introduction:
Pharmaceutical metered dose inhalers (pMDIs) traditionally used chlorofluorocarbons (CFCs) as the propellant but, under the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer1, the use of CFCs is being phased out. PMDIs were exempted from the original phase-out plan, due to their critical role in treating respiratory disease and the long timescale necessary to develop alternative propellants. However, in 1998 the Health Service Circular 1998/180: ‘Phase out of CFC containing metered dose inhalers for the treatment of asthma and COPD’2 advised healthcare professionals and senior NHS managers on the planned change-over process.
We are now nearing the end of the phase out of CFC-containing pMDIs, with only beclometasone remaining. One of the two remaining suppliers, Teva, discontinued their product, Beclazone, at the end of March 2010. Neolab are also discontinuing their generic beclometasone pMDI and estimate that supplies will be depleted by the end of June 2010, although this will depend on demand and uptake.
As last remaining stocks of these CFC-containing pMDIs are now rapidly depleting, any patients who are still prescribed these products will need to be switched to a suitable alternative as quickly as possible.
What does this mean to medicines management?
In order to minimise anxiety and confusion about the changeover, patients will need to be counselled thoroughly about their new inhalers as even those products which are reformulated on a ‘dose for dose’ basis will have some subjective differences. Patients should be advised that different taste, a different sound on actuation, or that the spray from the new inhaler may feel different in their mouth. They should be reassured that these effects are due to the change in propellant, and will not affect the way their medicine works.3
Further information for healthcare professionals about prescribing UK beclometasone dipropionate CFC-free inhalers for asthma is available from the Medicines and Healthcare products Regulatory Agency (MHRA).4
Information for patients on switching to CFC-free inhalers is available from the charity Asthma UK.5
Summary
Those responsible for medicines management in primary care should make it their priority to identify any patients still prescribed CFC-containing MDIs and recall them immediately for a full clinical medication review.
Community pharmacists can also reinforce this message when counselling patients or carrying out Medicines Use Reviews (MUR), or Prescription Intervention Services.
All members of multidisciplinary teams must play their part to ensure that the last remaining patients who are still using CFC-containing pMDIs are identified and fully supported through the transition process.
References:
(1) The Montreal Protocol on Substances that Deplete the Ozone Layer (1987). A protocol to the Vienna Convention for the Protection of the Ozone Layer. International treaty.
(2) Health Service Circular 1998/180: Phase out of CFC containing metered dose inhalers for the treatment of asthma and COPD.
Available from
www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/
Healthservicecirculars/DH_4004810
(3) NPC MeReC Bulletin Volume 9, Number 5, 1998.
Available from www.npc.nhs.uk/merec/resp/asthma/resources/merec_bulletin_vol09_no5.pdf
(4) MHRA Press release 2006: Medicines regulator informs healthcare professionals about prescribing UK beclometasone dipropionate CFC-free inhalers for asthma.
Available from
www.mhra.gov.uk/NewsCentre/Pressreleases/CON2024437
(5) Asthma UK. Switching to CFC-free Inhalers.
Available from www.asthma.org.uk/all_about_asthma/medicines_treatments/
switching_to_cfcfre.html
All websites last accessed 7th May 2010