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The metered dose inhaler, which is used by patients with asthma and chronic obstructive pulmonary disease, is about to undergo some substantial changes. Health professionals need to know why and how these changes are occurring so that they can ease their patients' transition from old to new.
The reason for the changes lies in the thinning of the ozone layer in the stratosphere. The possibility that chlorofluorocarbons, which are widely used as aerosol propellants and refrigerants, might deplete stratospheric ozone was first suggested 20 years ago.1 This caused concern because reduction of the ozone layer would permit increased exposure to ultraviolet B radiation, with the possibility of increased rates of skin cancer and cataracts and other less obvious effects on the immune system, vegetation, and plant and animal growth.2 3 Such postulated thinning had been confirmed over Antarctica by 1986. Government action had, however, predated this
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