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.


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. Giovanna
    Kingman, Arizona

    I am 26, I do not smoke or drink, and I have asthma. My doctor has prescribed ProAir. This is the most useless excuse of a rescue inhaler I have ever used. I have explained this to my doctor more times than I can remember to count and it’s like discussing my concerns with a brick wall. She keeps me on this useless medication. I have gotten to the point where I carry my nebulizer with me everywhere because my rescue inhaler does not work. As a result I have been put on Symbicourt for my asthma which helps but is not meant for asthma attacks It is only for controlling asthma enough to lessen the number of attacks. With this stated I have found relief in my asthma through using the symbicourt as prescribed daily and when I start feeling the tightness I sit upright and breathe slow deep breaths through my nose and out my mouth. I sip on hot tea or coffee which helps and if this does not help at any particular time it becomes time for the nebulizer. If I am not home when I have issues with my asthma I take slow deep breaths and remain calm until I can get my nubulizer out of my purse and plug it in to use it.

  2. Karen Jay

    Please consider: some people can not tolerate Albuterol. Beta II Agonists give me asthma which almost killed me one night. I didn’t know that my new prescription of Albuterol was different from my Primatene Mist that had been discontinued. I had gone camping and my husband had to rush me home, then I grabbed an old bottle of Primatene Mist that saved my life. I then tried Levalbuterol, same thing and my lungs were horrible the next day. Taking a shower closed off my lungs. That had never happened before!

    Also, please consider: some people can not tolerate steroids. I recieved steroid injections for 17 years until my body said NO MORE. I had a horrible reaction to an injection. Then I was put on Asthmacort in 1986 and I had a horrible reaction to that. The Dr. said, it can’t do that, (no drug books in those days) so I tried it again and it did it again, only worse. I can’t tolerate cortisone shots to my arthritic joints either. I am 62 years old, with healthy lungs, heart and physical condition and I have been controling my asthma attacks at night or from an asthma trigger, for 44 years. I have controlled it without steroids since 1986.

    I am proof that the status quo guidelines for asthma treatment aren’t always correct for everyone. It’s very upsetting to keep hearing this “one size fits all” advice everywhere nowdays. Drug books show Albuterol with the same side-effects as epinephrine. I saw a scientific study that showed they both worked as well as a rescue emergency treatment in children but the Albuterol had a longer discharge time and it had a relapse rate much higher than epinephrine.

    Right now, the FDA is considering pulling Asthmanefrin (racepinephrine) off the market, leaving only Albuterol type products, (Beta II Agonist), with a prescription, as a rescue inhaler. It will cause many deaths and ruin lives like mine. Why aren’t asthmatics given a choice? We are all different and as an asthmatic, since I was 15 years old, I know, MY type of asthma better than any doctor at this point. The doctor, I have now put me on Singulair, and yes it helps but not as a rescue inhaler, that I need to breathe, every night!

    My doctor told me that I mostly have night-time asthma because the pollution in the atmosphere lowers at night and my lungs close off when I lay down. He said, my asthma is very well controlled without steroids. It would be overkill. Steroids have many, bad, long- term effects. I should never have allowed my doctor to give me steroid shots, starting at age 15. What did I know then?

    But now is different. I will speak up. PLEASE help us stop the FDA from taking Asthmanefrin off the market!! Thank you for reading!

    Arch Pediatr Adolesc Med. 2004 Feb;158(2):113-8.

    A randomized trial of nebulized epinephrine vs albuterol in the emergency department treatment of bronchiolitis.

    Mull CC1, Scarfone RJ, Ferri LR, Carlin T, Salvaggio C, Bechtel KA, Trephan MA, Rissman RL, Gracely EJ.

    Author information



    To determine if nebulized epinephrine is more efficacious than nebulized albuterol in the emergency department (ED) treatment of moderately ill infants with bronchiolitis.


    Sixty-six patients between 0 and 12 months of age with new-onset wheezing, an antecedent upper respiratory tract infection, and a clinical score (Respiratory Distress Assessment Instrument) of 8 to 15 were randomized in a double-blind fashion to receive either 0.9 mg/kg of nebulized 2.25% racemic epinephrine (n = 34) or 0.15 mg/kg of nebulized 0.5% albuterol sulfate (n = 32) at 0, 30, and 60 minutes.


    Primary outcome measures were clinical score and respiratory rate. Secondary outcome measures were room air oxygen saturation, elapsed time to meeting clinical criteria for ED discharge, hospitalization rate, and proportion of patients relapsed within 72 hours of ED discharge (relapse rate).


    Both treatment groups experienced a similar pattern of change in mean clinical score, respiratory rate, and room air saturation over time. There were no significant differences between the groups by these same measures at any time. The median time at which infants were well enough for ED discharge was 90 minutes in the epinephrine-treated group vs 120 minutes in the albuterol-treated group (P =.01). Sixteen infants (47.1%) in the epinephrine-treated group were hospitalized compared with 12 infants (37.5%) in the albuterol-treated group (relative risk, 1.25; 95% confidence interval, 0.71-2.22). Relapse rate was 18.8% (3/16) in the epinephrine-treated group and 42.1% (8/19) in the albuterol-treated group (relative risk, 0.45; 95% confidence interval, 0.14-1.41). Adverse effects occurred infrequently.


    Although the patients treated with epinephrine were judged well enough for ED discharge significantly earlier than the patients treated with albuterol, epinephrine was not found to be more efficacious than albuterol in treating moderately ill infants with bronchiolitis.

  3. DARYL

    I have had asthma all of my life. I have learned to live with it. I have used albuterol inhalers, both CFC and HFA.
    After the change in 2008, I noticed immediately the new HFA inhalers were not working. I asked my pharmacist about this and he agreed. It appears to be another case of the government giving in to big business pharmaceutical lobbyist, because of generics. By passing a bill to prevent CFC inhalers in america, the drug manufactures stood to make big profits and do away with generic competition because of their expired patents. We all know that CFC’s from an inhaler is not going to alter the atmosphere! More importantly, CFC albuterol inhalers are being sold all over the world – just not in the united states. Worst of all the HFA inhalers have no medical benefits. Actually it is the opposite. HFA inhalers are less effective in treating asthma.
    I am very fortunate in that I can cross the Mexican border and buy CFC inhalers without a prescription. I take a vacation each year and buy a years supply. It is appalling to see drug manufacturer profiting at the expense of asthma patients wellbeing! God bless and if you need inhalers, take a vacation to Mexico.

  4. monica o

    I have been an asthmatic since i was born. I started using inhalers at the age of 2. one of the inhalers i used was primatine mist, an over the counter inhaler. which worked very well, until one day a doctor scared my mother by telling her i could die from it. so i was than prescribed albuterol, a heaven sent medication that worked wonders. but now albuterol has been switched with pro-air. this medication works, but not as well. i seem to use more pro-air to get the same results as albuterol. so with all these complaints in regards to this pro-air inhaler, what is being done? or is there anything that can be done about it?

  5. cheryle smit
    Placerville. Ca

    These new inhalers either don’t work or they don’t work for very long. I am always short of breath. I’m going to start using my nebulizer every day and see if that improves my shortness of breath. I welcome any suggestions

  6. Beverly

    The other night I had asthma issues brought on by allergies and possibly an infection, I reached for the Pro-Air and received a shock. Not only did it not help my breathing but it made me gag and choke and seemed to make the asthma worse. For years I used an albuterol inhaler successfully, but now I feel at the mercy of these new inhalers. My feeling is that the government should crack down on the corporate air polluters but allow asthmatics to use the albuterol.

  7. sandra r.
    United States

    I too have noticed that I am worse and worse on the new inhalants. I think a class action for those who are sicker and those who have died may be the motivational therapy these horrible companies need to change.

  8. Kai

    I noticed that my inhaler stopped working well while I was in college, so I started just having coffee or tea instead. It was at the same time the taste changed, which was probably when the propellant changed. I’m all for protecting the environment, but I prioritize my health comparatively. Due to perfume exposure (a major trigger for me, usually at work) and the inhaler not working, I had to get a nebulizer about a year ago and it works just fine, but, even with a spacer, the regular inhaler is far less effective than caffeine. I just took it and I didn’t notice a change in my asthma at all. I didn’t know the dosage for caffeine for asthma, but it takes far less than three cups for it to work and I don’t get the level of side effects that I get from the nebulizer.

  9. moe

    Yes, I totally agree about the inhalers not working. Proair, proventil and all the rest except for Maxair give no relief. Valeant Pharmaceuticals no longer makes Maxair as FDA has banned them -carbons. They have no concern for people who depend on these. We need these inhalers reformulated so we can exercise.

  10. Teresa

    I’ve been an asthmatic since I was 17, and I just turned 52 last week. I remember the CFC inhalers and did well on them. Since the new ones, I dare not go anywhere without my inhaler. Not even to the next room!
    I too, have been moved to the ProAir inhalers. I’ve been lucky enough to get a couple of Proventil & Ventolin inhalers but then had to go back to Pro Air. Because of this, I have discovered the cause of another problem I’ve been having- I smell smoke 24/7 everywhere I go. It smells like nasty cigarette smoke all the time & it drives me crazy. But when I get off the ProAir it goes away. Get back on the ProAir & it starts up again. It scared me to go to sleep because all I can smell is cigarette smoke. It affects my food taste too. I HATE ProAir !!!

  11. Sean L.

    My name is Sean I have had adult onset asthma for about 3 years. When I first had it the rescue inhaler was all I needed to feel better within minutes. I have been on all the steroids you can think of and they don’t work for me the doctor says I am not using them right, if I cough really hard and cough up phlegm I can breath much better I’ve noticed the new pro air and the Ventolin do not work like they used to this is so frustrating not being able to breath!

  12. JH

    I have had asthma for 47 years. The “new and improved” inhalers do not work. Plus, they are more expensive. I teach school, so I see students struggling to breath with a ProAir Inhaler. ProAir doesn’t work for me. I use Albuterol for a back up inhaler and Dulera for the everyday inhaler. Then, I am still on two allergy inhalers (Astepro and Nasonex), plus a a pill to help open my lungs.
    It is extremely sad to see people suffer AND/OR one of your doctors tell you to stop using your asthma medicines when you mention the cost of treatments.

  13. Lynn A

    I am now using a neb instead of a rescue inhaler-all HFA inhalers cause greater breathing difficulties! Burning lungs, shortness of breath, rash are just a few-end up with bronchitis :( FDA, doesn’t care-millions and millions of dollars have been made! The amt of CFCs in the old inhalers was miniscule and could have been kept for med purposes, but $ for big pharma won! The HFA contains greenhouse gases-who is this better for?

  14. ll

    The new inhalers don’t work for me at all. My asthma was well controlled with the CFC inhalers and the new HFA inhalers make me out of breath and don’t work. They are truly junk! I can’t believe our government was dumb enough to believe the manufacturing companies and sign the Montreal Protocol.

  15. S.W.

    I have been asthmatic my whole life. I’m 45 now. I had used the old style inhaler with far more success than the one that we have all been forced to use. Ever since the change, I have had far worse attacks and am constantly feeling short of breath and just plain tight in the chest. They don’t last as long or work as well. Bring back what works for those who need it!!!

  16. Dolly M. W.

    I was also taking the albuterol inhaler with the original propellent. It worked great with stopping my asthma attacks.
    With this new propellent, it dries my throat and sometimes cause me to have severe asthma attacks and almost stops me from breathing. In fact, it did this to me during the church service this morning.
    I have had problems ever since the propellent was changed. I have told my doctor about it. One time recently, I had to stop my car completely until I could get my breathing back to normal. These new propellents can stop your breathing.

  17. js

    i relate with all of you since i’ve been asthmatic for more than 40 years. I’ve even had the misfortune of being intubated… but if you want change in the medication, you’re preaching to the choir here… you need to be writing your senators and congressmen… OFTEN and PERSISTENTLY

  18. CS

    This is the first time I have commented, but feel I have too. My pharmacy switched me to ProAir Inhaler instead of my Ventolin. Ventolin works great for me.
    The ProAir doesn’t work for me. It doesn’t come out right, and I have to try to prime it several times before I can use it. That wastes money. ProAir is very spendy.
    My Pharmacy said it was just the same as Ventolin, except it is from a different company. NOT TRUE. Hope something is being done about this.

  19. Ruth

    I am on a daily dose of Advair 100/50, after weaning down from 250/50, and only have to use a rescue inhaler in some situations. I’ve had to change or stop blood pressure meds because they made my breathing worse, also.
    I’m now trying a daily dose of Reishi mushroom, with Shiitaki as a control. It does seem to make a difference and I’m trying to get off the Advair eventually. Caffeine does seem to lessen asthma attacks, I’ve used it for my son when he didn’t have an inhaler and for a co-worker with a horrible attack. Both times it did lessen the effects. It won’t replace an inhaler, but it seems to help in an immediate situation. It’s hard to tell in my case because I am a heavy caffeine drinker, but it may contribute to my control of asthma.

  20. MCR

    Thank you for this information. I now understand why my inhalers were not working as well as before.
    ProAir had a very little effect, leaving me coughing and gasping. I thought it was differences between brands. I also noticed the cost increased.

  21. ladyliza

    For all you asthmatics out there, I have found a couple of things to help you breathe. My mother had copd, and my son has exercise induced asthma in muggy or smoggy weather. First, is apple cider vinegar. I am not suggesting you stop your asthma meds, but use this along with it. 1 Tblsp in 3 T juice and then mix well with some water and chug. Never drink it strait! You need raw unrefined apple cider vinegar from Trader Joe’s or Whole Foods. This clears out all the phlegm in your lungs and that area. Another thing I always keep on hand is Mullein, an herb. You can buy online in liquid tincture or at Whole Foods, but its less expensive if you find the herb, and make a tea of it. Drink a cup daily. It’s better warm. I buy the herb at Food for Less or google it. I make several days worth at a time as it’s efficient. It takes about 15 minutes, and when you take a deep breath, you can finally breathe.
    I hear all the time from friends that the replacements for albuterol are not as good. Its all about the ozone layer in the atmosphere folks, like hair spray, the old remedy was eating it up.

  22. D.V. W.

    I am all kinds of meds for asthma I to would like to see them bring back the old albuterol.

  23. CR

    The CFC albuterol inhalers are still available in Mexico. I pay $4-$6 — depending on the pharmacy and season — for a package of three inhalers. This is the price at pharmacies located near the border, so I don’t know what the price would be further south. I blame Big Pharma and Congress. Shame on them!

  24. Gas...

    A few years back I wrote to People’s Pharmacy and asked where & how I could purchase an old asthma remedy that I used from time to time called: “Kellogg’s Asthma Relief”, it contains STRAMONIUM 650 mg & LOBELIA 160 mg. I received an answer that said in substance “Today’s inhalers are a better solution and Lobelia is a dangerous substance??? See your doctor”. I did see my doctor and he prescribed Ventolin HFA, I did not need to use it yet. I still don’t know why Lobelia is dangerous and what it can do or not do, but after reading all the problems I read above in the article, I feel safer with my old medication. Can anyone tell me what the problem is with Lobelia?
    Thanks for your help, I appreciate all the help & info you provide us.
    Peoples Pharmacy response: Here is the lowdown on Lobelia from a trusted source, the University of Maryland:
    As you will see, Lobelia is safe at low doses but hazardous when the doses become higher.

  25. NK

    I use Ventolin now that CFC albuterol is no longer available. I have also used Pro-Air. I agree with other commenters that Pro-Air was not effective, however I’ve been doing alright on the Ventolin.
    Muggy weather affects me a lot and at the worst of those days the Ventolin is effective for far less time than the recommended dosing time allows. On those days, I’m pretty much incapacitated and always attributed it to worsened lung function. Now I wonder if it’s that the Ventolin doesn’t work as well as I had thought.
    One thing that is better for me now is that the old style albuterol often caused an uncomfortable rapid heart rate for me which is not happening with Ventolin. So I guess there are trade-offs.

  26. ww

    I’ve just had my first experience with Pro-Air, and have nothing to compare it to. But it doesn’t seem to release much, and it takes two or three puffs to get any relief at all.
    And there was something better, and they took it off the market? Bummer!

  27. harrry L

    The new inhaleers ate terrible. My asthma is not out of control. Another generic replaced to increase somone’s profits – but this ‘improvement’ has serious consequences. And it is priced almost out of reach. Barbaric!
    A good cost effectiveness study would restore the old and inexpensive formulation. I hope the goveernment hurries on this one

  28. TB

    When my doctor first switched me to the new HFA albuterol I nearly wound up in the hospital. I cannot tolerate alcohol, it sent me into tacacardia.
    It took me nearly 5 hours to finally return to my normal pulse rate. I had to use a magnifying glass to find that it ontained 5% alcohol.
    He then prescribed MAXAIR since it did not contain alcohol. Now that that is off the market I am relagated to using Xopenex HFA which does not really help.
    In 2007 I contracted Graves Disease and suffered from atrial fibrilation. The use of the alcohol based albuteral can cause the tacacardia to initiate an atrial fibrilation attack. This leaves me with a serious issue if I have an asthma attack.

  29. LYNND

    As someone who has been on daily asthma controller drugs for over 25 years, and who before that suffered periodic asthma attacks since childhood, I speak from experience when I say that anyone who makes frequent use of a rescue inhaler, such as ProAir, does not have adequately controlled asthma. I am on a daily dose of an inexpensive (generic) corticosteroid medication via a nebulizer, known as Budesonide.
    Prior to receiving this more effective treatment and mode of delivery, I experienced frightening episodes of “rebound asthma” from the use of Advair. No matter what brand of corticosteroid inhaler I used, toward the end of the month I experienced sharp lung pains and shortness of breath, presumably because the dose, even though they are supposedly metered, would not remain consistent. I was also frustrated with “sticker shock” given that brand-name corticosteroid inhalers typically cost over $80 per month. When I switched to a nebulizer for corticosteroid delivery, I was able to exercise for the first time in many years without routinely feeling short of breath.
    For times when the Budesonide ampules are not enough, I have on hand yet another alternative. While the extended-release Vospire tablets are no longer on the market, generic extended-release albuterol tablets are. If the albuterol inhalers and/or tablets are not enough, I have an even better (but costly) alternative via a nebulizer-dispensed version of albuterol, a drug called Xopenex.
    Because I take my asthma control medications religiously and see a doctor for bronchial infections before my asthma veers out of control, I have managed to stay out of emergency rooms for decades despite what is considered a “moderate-severe” case. I only need my rescue inhaler periodically, and typically my ProAir inhaler expires before I use all of its contents. While I agree that the CFC-free propellants are not as good as the originals, the take-home message is that better treatment and control of one’s symptoms are necessary. I would urge readers who have these experiences to seek treatment by a specialist in pulmonology or allergy/immunology. With few exceptions, there is no reason in this day and age that one should land in an emergency room with adequate treatment.

  30. E R N

    Have used both the Ventilin and ProAir inhalers and found Ventilin to be slightly better than ProAir, but neither work nearly as well as the old Albuteral generic inhaler that I used to have. I have to use more puffs of the new stuff for only so so results and now use a nebulizer several times a month instead of a few times a year. Is there anything that we can do to get our old inhalers back?

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