man using an asthma inhaler

Q. I ran this morning and was having trouble breathing and felt tightness in my chest. I took 2 puffs of my expired inhaler because it was all I had. It did not help. I just drank about 10 oz. of coffee and I feel so much better. I am going to my doctor to get a new prescription of albuterol though.

A. Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA) is the bronchodilator that most physicians prescribe to open airways during an asthma attack. It sounds like you were experiencing exercise-induced asthma. This is a good reminder to keep all medications, especially asthma medicine, up to date!

In a pinch, caffeine can often be helpful for people with asthma. Physicians have known about the beneficial effect of coffee for treating asthma since at least 1859 (Edinburgh Medical Journal). Research has shown that caffeine can open airways and improve asthma symptoms (New England Journal of Medicine, March 22, 1984). The dose is around three cups of strong coffee for an average adult.

Caffeine is related to theophylline, an old-fashioned asthma drug. As a result, decaf coffee will not work. A methodical review of the medical literature concluded that caffeine can “improve lung function for up to four hours” (Cochrane Summaries, Oct. 5, 2011). When nothing else is available, a couple of cups of strong coffee might help.

ASTHMA INHALER CONTROVERSY

There is quite a lot of controversy surrounding the “new” HFA asthma inhalers compared to the old CFC inhalers. HFA stands for the propellant chemicals called hydrofluroalkanes. They have replaced the older CFCs (chlorofluorocarbons) which were believed to harm the ozone layer.

Many patients have complained that the HFA inhalers are less effective, even though the FDA maintains that they are just as good. Experts insist that while the “feel” of the inhaler is different, the effect of the medication is identical. Here is what visitors to our website say:

“When I was able to use the CFC albuterol inhalers, my asthma was well controlled. I could afford the medication on a limited income, and it lasted me for a few months.

“Then in 2008, when I was forced to switch to the HFA inhalers, my asthma has gotten worse. I can no longer tolerate certain smells. Too much cigarette smoke in my face sets me off. The smell of perfume leaves me gasping for air. When I take a walk, I have to walk slowly. There were times I’d lay in bed to sleep at night, and would find myself gasping for air.

“I’ve nearly passed out due to lack of air, and the HFA inhalers, both Pro-Air and Ventolin do not offer much relief. The Ventolin even causes side effects, such as giving me a respiratory infections, which makes breathing harder.

“And right now, I am having difficulty in breathing. My lungs feel like they are on fire, and I’m praying it doesn’t worsen. I’ve taken two puffs of the HFA Ventolin, and it doesn’t seem to be helping. I know how to take the inhaler, so it’s not me. It’s the inhaler.

“I also feel that our complaints have been largely ignored by the FDA, the Congress, the government in general. I want to see the CFC inhalers put back on the market. Once they are, we asthmatics will not need to live in fear of suffocating to death.” Missy


“The ProAir inhalers are not effective. They do not work! They do not last for the 200 doses they are supposed to; you are lucky IF they last for 50. And unlike the old inhalers most of the puffs you do get are wasted priming the stupid things. So you actually can use only a small part of the 50 working puffs. The propellant seems to leak out of them after you use them once. These inhalers don’t bring relief either. I have had to revert to using my nebulizer which is not convenient and severely limits my activities in comparison to having access to 1 puff of the old style albuterol inhaler!

“I have had several attacks recently get very serious and have almost gone to the E.R. for asthma treatment for the first time in YEARS; because I got no or very limited relief from the ProAir inhaler.

“I would like to have access to an inhaler that actually works. As it stands I am paying 5x as much for something that doesn’t work or provides very limited relief and in attempting to use this product I’m having to get refills 6x as often. I am paying a LOT more to feel a LOT worse!” Courtney


“My 16 year old son has had asthma all his life. For 11 years, he used albuterol, which had his asthma under control, along with other medications. However, for the last three months he has had to use the Proventil instead of the original albuterol (no longer on the market) and now he is having a lot of problems breathing and the Proventil does not bring any relief.

“He panics before a game (his asthma is primarily exercise induced) because if he has an asthma attack the Proventil is not going to work and he is going to wind up the the emergency room. What can we do to get the old albuterol back?” Mair


“Since getting ProAir I have only had congestion a few times, which prompted me to reach for the inhaler.  The ProAir made me feel worse!  I used an expired albuterol inhaler and finally got relief!” A.F.


“ProAir HFA inhaler is supposed to be a branded generic, but it is less effective than Proventil HFA inhaler. Of course, my insurance company charges less for ProAir than Proventil. Something’s wrong with the delivery system. The mechanisms of release with this new HFA propellant are complicated enough and neither of the HFA inhalers is a good as the old fashioned albuterol, even the generic.  But ProAir has a real problem. I have complained to my doctor and the FDA.” Samantha


If you would like to learn more about asthma, especially a radical idea about the infectious nature of hard-to-treat asthma, you might want to listen to our radio show: Asthma and Infection with Dr. Monica Kraft and Dr. David Hahn.

We would like to know how you are dealing with your asthma. Are the albuterol HFA inhalers doing the job? Is one better than another? Share your comments about caffeine, albuterol and other asthma treatments below.

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  1. Jamie
    Canada
    Reply

    We have a brand called Ventolin which I pay for instead of the generics. Its albuterol but under a different name up here. The generics dont get 200 puffs from them, I also have worse side effects from them. Ventolin is only a couple dollars more and each additional inhaler is cheaper then the first. It works better and longer then the generics but the change of propellant makes the spray weaker and its not cool like the cfc types so you cant feel it if you make a mistake inhaling ie it hitting high in the back of the throat. I am allergic to dust mites and dhring the summer even with a battery of several medications I am on I still have to take it several times a day until the humidity goes down and we can clear the house of the offenders, their parts and waste. The switch of propellants has affected Atrovent as well which is my other emergency inhaler. Taking both together and never knowing entirely if I had inhaled properly is very concerning to me. I would like to see the old propellant put back into place. Its crazy to blame the inhalers for the ozone hole. Industry and many many larger items contributd to that. Nature would likely replenish fast enough for the scant amounts that left the inhalers. Heck I can wear sunscreen and cover up and be just fine. If we cant breathe due to inhalers not working right, well we could die horribly. I dont want my kids to see that.

    • Jamie
      Reply

      I can attest coffee does help, caffeine pills not as well.

  2. chris
    SD
    Reply

    I have just been reading up on this from another site and learned one of the most important things about the HFA inhalers is to clean them or they may not work, or become ineffective all together. HFA builds up a film that blocks the meds. from getting to the lungs. Also I ran across a breathing method that may help, it’s called: Buteyko Breathing. It makes sense and I’m giving it a try.
    Thanks.

  3. k
    vermnt
    Reply

    I have chronic severe asthma–classified under COPD–and have had an absolutely wonderful life of really living, breathing, like no problems at all with respiratory difficulty due to 20+ years of theophylline. Now, it is being discontinued and I am panicking — my life basically will be over. It is extremely, extremely terrifying that just because it is classified as an “old medication” with side effects, that we people whose very life has been blessed/saved/preserved/improved are relegated to the sidelines of existence because some “professionals” feel there are better medications available. It took over 15 years of testing, in/out of hospital/loss of work, etc. to finally have a free wonderful chance of breathing thru life. And , now, what????? Yes, I do have a nebulizer with albuterol for isolated severe respiratory infections–but for daily use, theophylline/theo-dur has saved my life to where I have been able to function as a “normal” person with absolutely no problems whatsoever. What about US??? There are some of us who actually benefit from Theophylline/Theo-dur and now we have options of starting over with less-aggressive, less-effective (for us) medications. How dare the medical yahoos throw all of us into the pool of “too bad–we consider these medications dangerous”. I guess when you hit age 50, life is considered worthless to others and we can just literally jump into the grave.

  4. Liam
    USA
    Reply

    I hate all inhalers. I drink coffee constantly and when I quit stuff gets worse. I had no idea that inhalers had been changed. RX companies decided what we get and don’t get… what a mad world. Why are we not choosing for ourselves? We are the consumers they’re just companies probably will employees who do not have these issues. What if their kids had Asthma? Hmm. I bet they would buy the stuff from Mexico! Time I suppose to stop bitching and write them a nasty set of letters … 1000 or 10s of thousands would probably work?

  5. Jimbo
    Canada
    Reply

    I too have been using an inhaler for years but I always used Ventolin (salbutamol with a CFC propellant). I wasn’t informed by my doctor that the propellant had been changed to HFA. I noticed that the inhaler didn’t seem to work as fast or as well, and I found my lungs felt irritated or scratchy after using. I, too, seem to be more prone to lung infections than previously.

    As I have mild asthma and don’t use an inhaler that often I never gave it much thought. But now after reading about it I think that we as consumers should be able to choose a product with CFC’s for a propellant if that is what we want. Any effect on the environment or the ozone layer from these products seems to me would be relatively small.

  6. Greg P
    USA
    Reply

    Same as everyone I’ve had asthma for 50 years. Younger I almost died with allergies and asthma combined and spent days in the hospital getting better. Feather pillows almost killed me. Anyways.

    Yes albuterol. One puff I’m good for most of the day sometimes days. It would last 5-6 months sometimes. Depending on circumstances like winter when everyone runs the heaters I gasp for air. When farms are cutting hay or dry spells.

    But these new inhalers are a joke. If I get a month I’m lucky. 4 sometimes more puffs just to feel something in so much as a slight relief. But wheezing like mad. I lay in bed. Trying to calm myself down feeling like gasping for air. I have started rubbing Vicks vapor rub just to feel some slight improvement. The inhalers are an absolute joke. Bring back my albuterol. It works. It last 6 times longer and the most I ever have is 2 puffs and I’m breathing again without wheezing

  7. Matt
    Reply

    This is dangerous advice! Yes, caffeine is known to be beneficial for asthma attacks. INITIALLY. But caffeine will also routinely cause WORSENING of the symptoms later on. DO NOT USE COFFEE TO TREAT YOUR ASTHMA. People on blogs are not qualified to give you medical advice tailored to your specific needs.

    • Joe Graedon
      Reply

      Matt, we certainly hope no one would ever recommend coffee as a regular treatment for asthma. On the other hand, caffeine can provide some benefit in a pinch. For example, if someone left his asthma medicine in luggage that was unavailable during an airplane flight, a couple of cups of coffee can help open airways if necessary.

      For decades doctors prescribed theophylline, a compound that is chemically quite similar to caffeine, for asthma. Theophylline has fallen out of favor, but the pharmacology has not changed.

  8. doreen
    georgia
    Reply

    The cfc asmatha albuterol is the only inhaler that works for me. Where can i find them?

    • Alice
      Oregon
      Reply

      I totally agree that the new inhalers do not work as well as before the environmental caahanges..

  9. Marie B.
    DE
    Reply

    Once and for all, the new HFA Asthma Inhalers DO NOT WORK! I have had asthma for 25 years, and up until the change from CFC to HFA Asthma Inhalers, my asthma was controllable with the CFC in an emergency situation. Now, I live in fear. Unless you are an asthmatic, you have no idea the level of fear you experience during an attack. Just the simple act of reading a newspaper can bring on an asthma attack from the off-gassing of the print ink, or too strong a perfume worn by a passerby, or simply opening a bag of potatoes releasing mold spores.

    I have been on my knees gasping for breath, and getting little to no relief from the new HFA asthma inhalers. Often, it will take several puffs of the new inhaler to bring any relief; whereas, with the CFC, one puff was good enough to relieve my breathing difficulty during many asthma attacks. The quality of relief was better, too.

    And, yes, coffee does help when I’m having an asthma attack…not sure why, but I keep plenty on hand. I truly hope someone can help the asthma suffers get their CFC inhalers back.

  10. Lee
    MN
    Reply

    You can still get the old abuteral inhalers in Mexico for $7. They last 5 times as long. It’s criminal what the EPA and big Pharma has done with inhalers. The Federal government triggered the change with some BS ozone layer concerns and then big Pharma jumped on and lobbied for the change knowing they would make a fortune. I’m certain this change is killing hundreds of Americans a year. The price per puff has gone from 3 cents to around a dollar. Instead of having several inhalers in various places like your car and work and in your pocket etc. Most people can only afford one at a time. If they get separated from it or it runs out they’re dead. We need to some how start a movement to get thousands of those Mexican inhalers into the US like the movie Dallas Buyers Club.

    • Brieanna
      Wisconsin
      Reply

      Let’s start a movement. …how do we begin?

    • chris
      SD
      Reply

      How do you get the old inhalers from Mexico without going there? We live in the Mid-West so it’s not like it’s next door. If anyone could give me advice on this I would appreciate it.

      After reading your comments I am really worried about the new Ventolin HFA I just got a prescription for. My other inhalers have been CFC. As for coffee, I drink about 3 pots a day.

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