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Ozone Layer vs. Inhalers: a Tough Call


WASHINGTON — Nancy Sander cares about the environment, particularly the quality of the air she breathes. But when the goal of protecting the ozone layer collides with her family's access to life-saving inhalant medications, she will abandon her environmental ideals in a heartbeat.

Sander--and three of her four children--are caught in the middle of a public policy tug of war that is creating a state of high alarm among many of the 30 million Americans who have asthma, a potentially fatal respiratory ailment.

"When I have an attack, it's like someone is holding a pillow over my head," Sander said. "I reach for my inhaler, all the time saying, 'Thank God, thank God, thank God I have this!' "

But there's a catch: The inhaler propels its life-saving medication into her inflamed lungs with chemicals that destroy the Earth's protective ozone layer, which screens out the ultraviolet rays from the sun that can cause skin cancer.

The U.S. government has signed an international agreement to eliminate these propellants, although it has promised that this will not happen until effective alternatives are developed for life-or-death devices such as inhalers.

International environmentalists and public health experts hope that, by ridding the world of the remaining permissible uses of the propellant used in Sander's inhaler, they can head off a dangerous mixture of diseases, including a predicted jump in the number of potentially deadly skin cancer cases.

But to the nation's asthmatics, the threat posed by depletion of the ozone layer seems abstract and distant compared to their own predicament.

"I consider myself very environmentally aware, but I don't like feeling that the government is putting the environment before my health," said Sander, who heads the Allergy and Asthma Network / Mothers of Asthmatics. "Patients are not very excited about making changes to their medications because of the ozone."

Asthmatics see the greater danger as whether they will still be able to get their medicines--which must be taken for life--delivered as effectively by alternative propellants. For the most part, these alternatives have yet to be developed and tested.

Only one has been approved thus far, HFA-134a, which does not hurt the ozone layer. But experts still are not sure whether it will work for everyone and in all products. Other non-CFC propellants are under development, but it could be several years before they are approved.

Patients and their advocates worry that many years of testing--including studies after the products reach the market--may be required to ensure that alternatives work safely, particularly in children. But officials from the U.S. Environmental Protection Agency and the Food and Drug Administration stress that current CFC-containing products will remain available until there is convincing evidence that the replacements are safe and effective.

"EPA is not taking away asthma inhalers from any asthma sufferer," said Paul Stolpman, the agency's director of atmospheric programs in the office of air and radiation. "We are committed to healthy children and a healthy environment--but to healthy children first."

Chlorofluorocarbons, once viewed as among the most useful and versatile chemical compounds ever developed, were used in thousands of consumer products and industrial processes, from aerosol sprays to sterilizing agents for surgical instruments. They are perhaps best known for their use as coolants in air conditioners and refrigerators.

But scientists eventually determined that the substances were responsible for a frightening reduction in the stratospheric ozone layer, a situation that they believed would lead to increases in skin cancer and blindness, crop failures and disruptions of the marine food chain.

The result was the 1987 Montreal Protocol, signed by more than 130 nations, which set deadlines for stopping production of CFCs and similar chemicals. In the United States, CFCs were banned as of Jan. 1, 1996, except for certain products considered necessary, such as inhalers.

But the reprieve is only temporary--the idea is to phase out these uses of CFCs as soon as alternatives become available. The removal is not imminent--the EPA and the FDA insist that the timetable is flexible--but it is inevitable.

Despite the agencies' reassurances, asthma patients and their doctors are nervous about the transition, prompting Congress to take a look at the issue. The Senate Labor and Human Resources Committee conducted a hearing this past spring and lawmakers are considering whether to initiate legislation to block the planned phaseout by the two agencies.

Patients worry that global pressures to eliminate CFCs may accelerate their removal precipitously, putting patients at risk. They also fear that the cost of developing new propellants will result in their having to pay higher prices for their medicines.

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