HFA Propellant

What propellants are in metered-dose inhalers?
Why is there a different propellant in metered-dose inhalers?
Does the HFA inhaler feel and taste different?
What metered-dose inhalers contain the HFA propellant?
How do I clean my HFA inhaler?
How do I prime my HFA inhaler?
How do I use an HFA inhaler?
Can I still use a spacer/holding chamber with my HFA MDI?
How can I tell if the MDI is empty?

 

What propellants are in metered-dose inhalers?

The metered-dose inhaler (MDI) was developed in the 1950s. The propellant used in MDIs until recently contained CFCs (chlorofluorocarbons). You may find when you replace your MDI that a different propellant is used in the inhaler. This is an HFA (hydrofluoroalkane) propellant.

 

Why is there a different propellant in metered-dose inhalers?HFA (hydrofluoroalkane) propelled inhaler.

CFCs, the propellant in MDIs until recently, were found to deplete the ozone layer high above the earth. The Montreal Protocol was enacted worldwide to reduce the amount of CFCs used, to decrease the ozone depletion. CFCs have been used in many products, including MDIs.  Alternative devices have been developed to replace the CFC propellant in MDIs. Dry powder devices and the HFA propellant in MDIs are replacements for the CFC propellant.

 

Does the HFA inhaler feel and taste different?

The HFA inhaler looks the same as the CFC inhaler. There is a metal canister inside a plastic case. You may notice a difference when you use the HFA inhaler.  The HFA inhaler has a “softer, warmer” spray that the CFC inhaler.  It also may taste a little different.  You may not feel the spray as much at the back of your throat.  Remember to use correct technique when you take the medicine. You will still inhale the medicine into your lungs with correct technique, even though you don’t feel the spray as much.

 

What metered-dose inhalers contain the HFA propellant?

Many of the metered-dose inhalers have changed to the HFA propellant in the past several years.  The table below is a current list of metered dose inhalers with the HFA propellant.

 

How do I clean my HFA inhaler?

The HFA propellant is stickier than the CFC propellant. The HFA propellant may build up where the metal canister meets the plastic case of the MDI. Cleaning your MDI is different depending on the medicine in the MDI. The table below describes how to clean the plastic case for each medicine with an HFA propellant.

 

How do I prime my HFA inhaler?

Priming is spraying the medicine into the air before you use the MDI. This allows for an accurate dose when you inhale the medicine. MDIs need to be primed before the first dose and when not used for a period of time. Priming your MDI is different depending on the medicine in the MDI. The table below describes how to prime the MDI with each medicine containing an HFA propellant.

HFA Inhalers

Bronchodilator Medicine

Brand (Generic)

# of puffs in canister

Cleaning

Priming

Other

Atrovent® HFA (ipatropium)

200

  1. Take the metal canister out of the plastic case.
  2. Wash the plastic case weekly, running water through the case.
  3. Shake off excess water.
  4. Air dry.
  5. Put the plastic case and metal canister together when completely dry

Before first dose: 2 sprays

After 3 days of non-use: 2 sprays

 

ProAir HFA (albuterol)

200

  1. Take the metal canister out of the plastic case.
  2. Wash the plastic case weekly, running water through the case.
  3. Shake off excess water.
  4. Air dry.
  5. Put the plastic case and metal canister together when completely dry.

Before first dose: 3 sprays

After 2 weeks of non-use: 3 sprays

 

Proventil® HFA  (albuterol)

200

  1. Take the metal canister out of the plastic case.
  2. Wash the plastic case weekly, running water through the case.
  3. Shake off excess water.
  4. Air dry.
  5. Put the plastic case and metal canister together when completely dry.

Before first dose: 4 sprays

After 2 weeks of non-use: 4 sprays

 

Ventolin® HFA (albuterol)

200

Dose counter on MDI.

Replace when counter gets to 000 or 6 months after opening package, whichever comes first

  1. Take the metal canister out of the plastic case.
  2. Wash the plastic case weekly, running water through the case.
  3. Shake off excess water.
  4. Air dry.
  5. Put the plastic case and metal canister together when completely dry.

Before first dose: 4 sprays

After 2 weeks of non-use: 4 sprays

When dropped:  4 sprays

After washing: 1 spray

.

Xopenex HFA (levalbuterol)

200

  1. Take the metal canister out of the plastic case.
  2. Wash the plastic case weekly, running water through the case.
  3. Shake off excess water.
  4. Air dry.
  5. Put the plastic case and metal canister together when completely dry.

Before first dose: 4 sprays

After 3 days of non-use: 4 sprays

 

Anti-Inflammatory Medicine

Brand (Generic)

# of puffs in canister

Cleaning

Priming

Other

Alvesco®
(ciclesonide)

60

Dose indicator

Discard when dose indicator gets to 0

 

Before first dose: 3 sprays

After 10 days of non-use: 3 sprays

Rinse mouth with water, gargle and spit out the water after using the medicine.

Flovent® HFA (fluticasone)

120

Dose counter on MDI

Replace when counter gets to 000.

  1. Wet a cotton swab. Wipe the opening where the metal canister meets the plastic case.
  2. Remove the cap. Keep the canister in the case.

Before first dose: 4 sprays

After 1 week of non-use: 1 spray

When dropped:  1 spray

Three doses available (44, 110, 220)

Rinse mouth with water, gargle and spit out the water after using the medicine.

Store the MDI with the mouthpiece down.

QVAR® (beclomethasone)

100

  1. Clean the mouthpiece weekly by wiping with a dry tissue or cloth. Do not wash or put any part of the inhaler in water.

Before first dose: 2 sprays

After 10 days of non-use: 2 sprays

Two doses available (40, 80)

Rinse mouth with water, gargle and spit out the water after using the medicine.

Combination Medicine

Brand (Generic)

# of puffs in canister

Cleaning

Priming

Other

Symbicort® (budesonide and formoterol)

120

Actuation counter.  Replace when counter gets to 0.

Replace 3 months after opening the package or after 120 puffs, whichever comes first.

  1. Wipe the mouthpiece of the plastic case with a dry cloth weekly. Do not wash or put any part of the inhaler in water.

Before first dose: 2 sprays

After 7 days of non-use: 2 sprays

When dropped: 2 sprays

Two doses available (80, 160)

Rinse mouth with water, gargle and spit out the water after using the medicine.

Do not take the unit apart.

Store the MDI with the mouthpiece down.

Advair® (fluticasone and salmeterol

120

Dose counter on MDI

Replace when counter gets to 000.

  1. Remove the cap. Keep the canister in the case.
  2. Wet a cotton swab. Wipe the opening where the metal canister meets the plastic case.

Before first dose: 4 sprays

After 4 weeks of non-use: 2 sprays

When dropped: 2 sprays

Three doses available (45, 115, 230)

Rinse mouth with water, gargle and spit out the water after using the medicine.

 Dulera®

(mometasone and formoterol) 

 120

Dose counter on MDI

Replace when counter gets to 000

 

  1. Wipe the mouthpiece with a dry, lint-free cloth every 7 days of use.

 Before first dose: 4 sprays

After 5 days of non-use: 4 sprays

Two doses available (100, 200)

Rinse mouth with water, gargle and spit out the water after using the medicine.  

How do I use an HFA inhaler?

Correct technique is important when inhaling your medicine with any device. Take your inhaled medicine with you when you visit the doctor.  Your doctor or nurse can watch your technique to make sure you are getting the medicine.

Remember to follow these steps when you use your MDI:

1. Remove the cap from the inhaler.

2. Hold the inhaler with the mouthpiece at the bottom.

3. Shake the inhaler.  This mixes the medication properly.

4. Gently breathe out.

5.  Check the box with the technique your health care provider recommends and follow the step:

  • Use a spacer/holding chamber – Place the MDI in the spacer holding chamber.  Seal your lips around the spacer/holding chamber mouthpiece.
  • Use open mouth technique - Hold the mouthpiece 1½ - 2 inches (2 - 3 finger widths) in front of your mouth.
  • Use closed mouth technique – Place the mouthpiece in your mouth with your lips sealed tightly around the mouthpiece.

6. Tilt your head back slightly and open your mouth wide.

7. Press the inhaler and at the same time begin a slow, deep breath.

8. Continue to breathe in slowly and deeply over 3 - 5 secondsBreathing slowly delivers the medication deeply into the airways.

9. Hold your breath for up to ten seconds. This allows the medication time to deposit in the airways.

10. Resume normal breathing.
 

Repeat steps 3 - 10 when more than one puff is prescribed.

 

Can I still use a spacer/holding chamber with my HFA MDI?The AeroChamber® is a common spacer/holding chamber.

A spacer/holding chamber is a device that is placed between the MDI and your mouth. 

A spacer/holding chamber can improve your MDI technique. The spacer/holding chamber helps you coordinate the timing of activating the MDI and breathing in. Children and older adults may find it difficult to coordinate the timing and may find a spacer/holding chamber helpful. Anybody may find it difficult to coordinate the timing when having trouble breathing and may find a spacer/holding chamber helpful.

A spacer/holding chamber can also trap larger particles in the spacer.  These particles are more likely to stay in the mouth and cause more side effects.

When using a spacer/holding chamber with the HFA propellant the spacer/holding chamber should be anti-static. The spacer/holding chamber should also have a one-way valve to help you coordinate the timing of activating the MDI and breathing in. The space in the spacer/holding chamber should be large enough. The AeroChamber® is a common spacer/holding chamber.

 

How can I tell if the MDI is empty?

The canister of your MDI is marked with the number of puffs (actuations) in the canister. There are more puffs of propellant in the MDI than medicine. The MDI may feel as if there a number of puffs left when you shake the inhaler, but the medicine is gone and only propellant is left. It is a good idea to figure out how long the medicine will last. Then plan ahead so that you get a new inhaler before the old one is used up.

Some inhalers have a built in counter to show how long the medicine will last. The numbers count down when a dose is sprayed. When you get to 000 stop using the inhaler and start using a new inhaler.

If your inhaler does not have a counter, write the date you start using each inhaler on the inhaler. Place a piece of tape on the plastic case and write the date on the tape.

Date & Estimate

If you use your MDI every day you can keep track of how much medicine you use by Date & Estimate:

________ The number of puffs in your inhaler

________ Divided by the number of puffs you take each day

________ Equals the number of days the inhaler will last

Example:

  200 puffs in your inhaler

  4 puffs a day

  50 days your inhaler will last

Once you know the number of days your inhaler will last, add the number of days to the day you start using the medicine.  Along with the date you start using the inhaler, write the date you need to stop using the inhaler on the plastic case.

Date & Tally

If you use your MDI when you have trouble breathing you can keep track of how much medicine you use by Date & Tally:

Place a large piece of tape on the MDI. Remember to write the date you start using the MDI on the tape. Each time you use the MDI place a tally mark on the MDI (one tally mark can equal 2 puffs). You can count the tally marks to see when all the medicine has been used. You can also place tally marks on a calendar or paper near the inhaler.

Whichever technique you use, remember to figure out how long the medicine will last. Then plan ahead so that you get a new inhaler before the old one is used up.

Whichever device you use, make sure you know:

  • How to use the device
  • How to tell when the device is empty
  • How to clean the device

Also check the package insert that comes with the medicine for more information.

 

This information has been approved by Ann Mullen, RN, MSN,CNS, AE-C  (January 2014). © Copyright 2008, 2009, 2010, 2011, 2013. National Jewish Health