Expert: Marc Rubin, RPh Asthma Educator - 6/10/2010

Question
I have been on Albuterol for as long as I can remember. A couple years ago, they came out with a new formula (red cap). That mixture caused more problems for me ... even more shortening of breath, horrible after-taste (causing me to near vomit), severe dizziness and lightheaded ... for me, the asthma was heaven compared to the side-effects of the new formula. For that reason, I stopped taking Albuterol (as my PCP claimed the old formula was discontinued).

To my question; my mother says (when I told her I miss the old formula and can't take the new formula) that when she worked for a pharmaceutical company that she learned Albuterol does NOT have a shelf life. It's stamped with an EXP date for legal reasons, but is just as effective well past the EXP date ... up to approximately 5 years after the EXP date.

I've tried to google for supporting evidence, but I can't find anything. I know the medical standpoint is to never take medication after it's EXP date. What is the actual use of Albuterol after its EXP date?

Answer
Hi Wolfe,

The old formula was discontinued worldwide due to the propellant used (it destroys ozone in the atmosphere). In fact just recently, the rest of the various metered dose inhalation products containing that same propellant (CFC) are being discontinued.

The new propellant (HFA) has a number of differences, some of which you have already seen. One thing you are not aware of is that your inhaler (ProAir HFA) is not exactly identical to the other two new products: Ventolin-HFA and Proventil-HFA. The unit with the characteristics closest to the old albuterol is the Ventolin-HFA.

Things you need to be aware of:
1) the particle size of the albuterol molecule is smaller, allowing deeper penetration into the lungs,
2) yes, the taste is different, even between the three new formulations,
3) the units need to be cleaned on a regular basis (if used daily, clean weekly), due to the new propellant having a higher propensity for clogging.
4)technique is VERY important. Up to 75% of users do NOT use the device properly. Here is the link:

http://www.ventolin.com/how-to-use-ventolin-hfa/how-to-use-ventolin-hfa.html

People frequently actuate the unit BEFORE inhaling. You BEGIN slowly inhaling JUST before triggering the device, so the mist enters mid-stream, and you continue inhaling for the full breath. Hold your breath for 5-10 seconds, then slowly exhale. Wait a full minute, then repeat.
It is also of benefit to be looking up at an angle: e.g: like looking up at a clock on the wall. This gives a better curve to the airflow, rather than when you look straight ahead or down, where more of the mist ends up against the back of the throat.

Finally, the Ventolin-HFA is the ONLY rescue inhaler with a dose counter on it.

As to actual expiration date, the governments Veterans Hospitals have done there own testing and have found that the expiration dates are indeed conservative. Therefore, they follow their own research results. As far as your mothers point of view, one has to consider the interactions between the active chemical and the other components in the canister, which are now different that in the past, and I'm not qualified to make an authoritative statement to that issue.

Hope this helps.

Sincerely,

Marc