What is the fate of Combivent inhaler?

I just saw a patient who uses Combivent metered-dose inhaler (mdi). She's quite happy with it and has been using it for years. Problem: Combivent sales, along with sales of other traditional inhalers that use CFC as a propellant (read: albuterol mdi is the 800 pound gorilla on this block), will be prohibited by federal law on 12/31/08. The reason is to get in compliance with the Montreal protocol. [For more information on this, go to the blog labelled "Asthma inhalers use HFA as the propellant not CFC.] So what's she supposed to do?

I searched the internet for some answers, but I did not find any simple or satisfying answers. Unlike for albuterol mdi, there is no replacement called Combivent HFA. The reason is that Combivent is a combination of two medications: albuterol and ipratropium (left, trade name Atrovent). Both must be dispensed in equal amounts from the inhaler, using the newer propellant HFA. This product has been reportedly tested. However Combivent HFA will not be approved and marketed by 12/31/08. So patients will have to consider their options. First, just use an albuterol-brand name HFA inhaler. If ipratropium helped, then be prepared for symptoms. Another medication may be needed to gain control. Second, to get the equivalent amount of the two medications, use an albuterol-brand name inhaler plus Atrovent HFA (pictured below), meaning use 2 inhalers where previously they used only one. I admit it looks just like Atrovent mdi.

Progress can be painful sometimes. I agree it is important to protect the ozone layer. Until Combivent HFA is approved, these are your options.