What Is The Difference Between Ventolin HFA And ProAir RespiClick?
In our latest question and answer, the pharmacist compares ProAir RespiClick to Ventolin HFA.
I am starting a new inhaler called Ventolin HFA and I been taken ProAir RespiClick. Are these two the same? Also, do they have the same side effects?
Ventolin HFA and ProAir RespiClick contain the same active ingredient, albuterol sulfate. The actual inhalers, however, are quite different. I discuss these differences below.
What Is Albuterol?
Albuterol is classified as a SABA, or 'short-acting beta-agonist'. Informally, it is known as a 'rescue ' medication since it is a fast-acting bronchodilator, opening up the airways quickly if you are experiencing an asthma attack.
According to the Expert Panel of the National Asthma Education and Prevention Program (NAEPP), albuterol is the preferred treatment option in those suffering from an acute asthma attack due to its effectiveness and safety.
Albuterol inhaler products have an interesting and somewhat confusing history.
Originally approved by the FDA in the 1980s, albuterol had been available generically for years, making them an affordable option for the management of acute asthma symptoms. The propellant used in these generic albuterol inhalers were CFC's, chlorofluorocarbons.
Per the Montreal Protocol on Substances that Deplete the Ozone Layer, CFC's were to be phased out due to their destructive effects on the ozone layer.
Inhalers containing CFC's in the United States were not to be sold after December 31, 2008. In the case of albuterol, a new propellant, HFA (hydrofluoroalkane), would be used going forward.
Unfortunately, albuterol HFA inhalers were technically considered new drug products, even though they contained the same active ingredient (albuterol) that has been used for years.
Albuterol inhalers transitioned from being available generically, to only being available as 'branded' products, like ProAir HFA, Ventolin HFA, and Proventil HFA. Eventually, non-propellant albuterol inhalers, like ProAir RespiClick would become available.
Below I discuss the two inhalers you asked about, Ventolin HFA and ProAir Respliclick
In 2015, a new albuterol product, a powdered metered dose inhaler (not HFA) was approved by the FDA, ProAir RespiClick. Instead of using a propellant, ProAir Respiclicks contains albuterol in a powdered form.
Unlike propellant inhalers, like Ventolin HFA, with ProAir RespiClick, the powder is inhaled when you breathe in through the mouthpiece. There is no button actuator that releases the medication.
Dry powder albuterol inhalers like ProAir Respiclick have several potential advantages over propellent albuterol inhalers, including
- They don't require you to coordinate breathing in while pressing an actuator since you are actively breathing in the powder. As simple as this sounds, many individuals have difficulty with this hand-breath coordination, leading to inefficient dosing.
- Since the albuterol powder is released when you take a breath, this eliminates the need for 'spacers', like Easivent.
- The inhalers do not need to be primed or shaken prior to use.
ProAir RespiClick is dosed just like HFA albuterol inhalers and cost about the same (~$50 per inhalers), but your copay may vary per your insurance plan.
Ventolin HFA is simply an albuterol inhaler that uses HFA instead of CFC as the propellant.
HFA inhalers have been reported widely to not be as effective as CFC inhalers and that they 'feel different'. Nevertheless, most studies find that there is no difference between them in regard to their effectiveness.
The FDA put together a Q+A sheet about the transition from CFC to HFA inhalers and stated the following regarding effectiveness:
Q: The spray feels different, how will I know if my HFA inhaler is working in the right way?
It is important to remember that it is the deep breath that you take with each puff that gets the medication into your lungs, not the force of the spray. The spray from an albuterol HFA inhaler may feel softer than the spray from an albuterol CFC inhaler but this will not affect the amount of drug that you breathe into your lungs. The spray from an albuterol CFC inhaler often hits the back of the mouth. The spray from an HFA inhaler is a fine mist that may actually be easier to breathe into your lungs compared to a CFC inhaler.
Since Ventolin HFA and ProAir RespiClick contain the same active ingredient (albuterol), their potential side effects are the same (e.g. increased heart rate, sweating).
Both products contain 200 doses and are dosed the same way (generally one to two doses every four to six hours as needed).
- Ventolin HFA and ProAir RespiClick both contain albuterol sulfate and are dosed the same way.
- ProAir RespiClick does not contain a propellant but utilizes a dry powder instead.
- ProAir RespiClick may have several advantages over albuterol HFA inhalers since it doesn't require hand-breath coordination to dose correctly. It also doesn't require priming.
- The price of Ventolin HFA and ProAir RespiClick are similar, but your actual cost will vary by pharmacy and your specific insurance plan.
- Elsevier ClinicalKey: Albuterol Sulfate Monograph
- Transition from CFC Propelled Albuterol Inhalers to HFA Propelled Albuterol Inhalers: Questions and Answers. FDA Website
- Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. PubMed
- Withdrawal of albuterol inhalers containing chlorofluorocarbon propellants. PubMed