The albuterol inhalers used by millions of people to help them breathe are having unhealthy consequences on the environment.

The United States and most other countries have agreed to phase out by Dec. 31 propellants called CFCs (chlorofluoro-carbons) that are used to help push albuterol into the lungs of patients with asthma, emphysema and other airway diseases.

The reason: CFCs have been found to damage the atmosphere's ozone layer.

Patients need to switch to inhalers that use a different propellant, called HFA (hydrofluoroalkane) by the end of the year, according to U.S. Food and Drug Administration.

The FDA recommends that anyone who still is using a CFC-propelled inhaler talk to his or her doctor as soon as possible about switching to another medicine.

According to the government, there are three approved HFA-propelled albuterol inhalers on the market: Propair HFA Inhalation Aerosol, Proventil HFA Inhalation Aerosol and Ventolin HFA Inhalation Aerosol.

In addition, another HFA-propelled inhaler called Zopenex HFA Inhalation Aerosol contains levalbuterol, a medicine similar to albuterol, according to the FDA.

Patients who switch inhalers might notice that the HFA-propelled products taste different and have a softer spray, the FDA said. But that doesn't mean the inhaler is broken or that the medicine isn't working.

Each inhaler has different priming, cleaning and drying instructions, so read patient information carefully, the FDA advises.

Emergency in the ERs

A new study is pointing to a potential communication emergency in the nation's ERs.

More than three-quarters of patients don't completely understand the care and discharge instructions they receive in the emergency department, according to a new study published online Monday in the Annals of Emergency Medicine.

Study author Dr. Kirsten Engel of Northwestern University in Chicago and co-researchers assessed how well 138 patients and two caretakers comprehended diagnosis and cause, emergency department care, post-emergency department care, and return instructions.

''It is disturbing that so many patients do not understand their post-emergency department care, and that they do not even recognize where the gaps in understanding are,'' Engel said in a prepared statement. ''Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department.''

Engel recommends that patients help themselves by asking emergency department staff to repeat themselves and clarify points that remain unclear.

Patients also can benefit by bringing a family member or friend with them to the ER whenever possible to ask questions and help remember the post-discharge instructions, she said.

Engel's advice: ''When you are in the emergency department, be honest and don't be afraid to ask questions. If you don't understand what the doctor has told you, keep asking questions until you do. That's what we're there for.''