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The Breezhaler® dry powder inhaler (DPI) has a low carbon footprint compared with other inhalation therapies, consistent with the literature on other DPIs. This life-cycle assessment was conducted in France, Germany, the UK, and Japan using a “cradle-to-grave” technique to evaluate six environmental impact categories (global warming potential; acidification; ozone depletion; use of resource, minerals, and metals; eco-toxicity; and freshwater use) associated with the use of the Breezhaler®. Three variants of the Breezhaler® (30-day packs with and without the digital companion and a 90-day pack without the digital companion) were evaluated to identify major hotspots in the device life-cycle and to provide realistic solutions to reduce the environmental impact. Although no single life-cycle stage dominated the climate change impact of the 30-day device with the digital companion, the inhaler’s raw materials and packaging contributed to 96% of the resource depletion impact for the 30-day device without the digital companion. For the 90-day device without the digital companion, packaging contributed 42–62% of the impact across all categories. Overall, the Breezhaler® inhaler with the 90-day pack had the lowest environmental impact. The environmental impact of the device did not vary significantly among the considered markets. Further studies are needed to assess the impact of active pharmaceutical ingredients and improvement in clinical outcomes on the environment.

When selecting the best inhaler and drug combination for a patient with respiratory disease, a number of factors should be considered. While efficacy and safety of medical treatments are always a priority, in recent years the environmental impacts of all aspects of life have become an increasingly necessary consideration and inhaled therapies are no exception. The carbon footprint of an item, individual, or organisation, is one of the most important and quantifiable environmental impacts, assessed by the amount of greenhouse gases (often expressed in terms of CO2 equivalents) generated throughout the life cycle. The two most commonly prescribed and manufactured inhaler types worldwide are pressurised metered dose inhalers (pMDIs) containing hydrofluorocarbon (HFC) propellants and dry powder inhalers (DPIs). Most of the carbon footprint of current pMDIs is a result of the propellants that they contain (HFC-134a and HFC-227ea, which are potent greenhouse gases). In comparison, the powder in DPIs is dispersed by the patient's own inhalation, meaning DPIs do not contain a propellant and have a lower carbon footprint than most pMDIs currently available. Soft mist inhalers are another propellant-free option: the device contains a spring, which provides the energy to disperse the aqueous medication. In this review, we will examine the published data on carbon footprint data for inhalers, providing an analysis of potential implications for treatment decision making and industry initiatives.

No abstract

Respiratory inhalers have a substantial impact on the carbon footprint of the healthcare sector. Environmental factors, including carbon footprints, are gaining importance in choosing inhalers once medical considerations have been addressed. This paper provides a review of the carbon footprint (CFP) and life cycle assessment (LCA) environmental profile of dry powder inhalers (DPIs) and pressurized metered-dose inhalers (pMDIs). Despite methodological challenges, our analysis reveals that the CFP varies between DPIs ranging from 359 gCO2e per inhaler (Enerzair Breezhaler® DPI without digital companion 30-day pack) to 1250 gCO2e per inhaler (Seretide Accuhaler® 50/500) and from 6.13 gCO2e per dose (Enerzair Breezhaler® without digital companion 90-day pack) to 27 gCO2e per dose (Relvar Elipta 92/22). The breakdown of inhaler CFP by life cycle stage reveals that, although the use and end-of-life stages together contribute to most of the CFP of the MDIs, the largest contributions to the CFP of the DPI/SMI are made by the API and manufacturing stages of the life cycle. Although from a climate perspective our review aligns with the findings of Jeswani and Azapagic that DPIs have a lower CFP than pMDIs, we conclude that the performance against other environment impact categories depends on the design, choice of material and manufacturing process of the DPIs. The challenge of comparing the CFP of different inhalers can be made easier by the standardization of study boundaries and methods.