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.

Join Over 80,000 Subscribers at The People's Pharmacy

Each week we send two free email newsletters with breaking health news, prescription drug information, home remedies and a preview of our award-winning radio show. Join our mailing list and get the information you need to make confident choices about your health.

  1. Lee

    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.

What Do You Think?

We invite you to share your thoughts with others, but remember that our comment section is a public forum. Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions. Comments that do not follow these policies will not be posted.