Joseph Malekovic, 45, is a self-described liberal environmentalist. The LaPorte resident gets upset when he sees a gas-guzzling Hummer.
But after Malekovic began using a more environmentally friendly inhaler last year, he had trouble summoning enough air to play catch with his 9-year-old son. Malekovic could hardly speak, felt miserable and was constantly short of breath.
At one point, the normally tough guy became so ill he thought he might die.
So he reached for his old rescue inhaler, the one that uses CFCs to pump medicine to open the airways during an asthma attack.
CFC albuterol inhalers were banned at the end of 2008 as part of a decades-long international effort to phase out CFCs, or chlorofluorocarbons, which damage the Earth’s ozone layer.
The rescue inhalers had been exempted from being banned in the U.S. since 1996 while the Food and Drug Administration settled on what it considered a suitable alternative – inhalers using hydrofluoroalkane, or HFA, as propellant.
Malekovic says he’s all for a viable alternative to CFC inhalers, but he and others struggling with the change say HFA inhalers aren’t it.
Ozone aid disputed
However, many opponents question the environmental benefit of banning CFC rescue inhalers in the first place, and the governmental regulatory impact study done before the ban does little to bolster the argument.
The 2005 FDA study stated it was “unable to quantify the environmental and human health benefits of reduced (ozone-depleting substance) emissions from this regulation.” It assumed benefits were captured by earlier Environmental Protection Agency estimates but provided no examples.
The study also said that: “As a share of total global emissions, the reduction associated with the elimination of albuterol CFC (metered-dose inhalers) represents only a small fraction of 1 percent.”
The FDA speculated that reduced exposure to UV-B radiation as a result of reduced emissions would help protect public health.
“However, we are unable to assess or quantify specific reductions in future skin cancers and cataracts associated with these reduced emissions,” the study read.
International efforts before and after the 1987 Montreal Protocol to halt CFC production for a range of product uses, such as refrigeration and hairspray, have helped protect and restore the ozone layer, according to subsequent reports.
The common perception that the ozone problem has been solved is essentially true, said Drusilla Hufford, director of the agency’s stratospheric protection division.
But Hufford said many harmful compounds are expected to remain in the stratosphere for some time – thousands of years, in some cases.
CFCs also contribute to global warming, Hufford said, and have mostly been phased out of production worldwide. Although inhalers are minute contributors by comparison, Hufford argued that progress wouldn’t have been possible if special exemptions had been carved out for smaller CFC sources and such sources remained in production indefinitely.
Politics vs. health
But others see the ban on CFCs as merely a symbolic exercise – one that offered up asthmatics and others who have struggled to make the transition to HFA inhalers as sacrificial lambs.
“There was never any evidence offered by the EPA … to prove … to demonstrate that CFC (metered-dose inhaler) emissions could or would in and of themselves threaten the ozone layer, increase ground UV-B radiation, or increase skin cancer rates,” said Arthur Abramson, co-founder of The National Campaign to Save CFC Asthma Inhalers. “The whole argument was one of political expediency.”
Abramson has a stockpile of CFC inhalers to get him by after trying all four HFA equivalents with no success. He’s spoken with many others facing similar problems, including Malekovic.
After four decades of managing his asthma, Malekovic gets panicky when he thinks about what might happen when his trusty CFC inhalers run out. He’s tried several HFA inhalers and now uses Xopenex HFA, which is made by Marlborough, Mass.-based Sepracor Inc.
Malekovic “survives,” as he puts it. He plays catch with his son but still can’t find the breath to call out the name of White Sox players, a ritual of theirs. He still has a lot of itching and burning in his lungs, although less than with his other HFA inhalers. He is constantly congested and sometimes becomes ill.
So Malekovic takes periodic puffs from a CFC inhaler for more relief.
“Once they’re gone,” he said, “I’m not going to be doing as well.”
