Climate change in healthcare: Exploring the potential role of inhaler prescribing

Abstract

Climate change has been described as the biggest global health threat of the 21st century. As a result, governments around the world are committing to legislative change in order to reduce greenhouse gas emissions (GHGEs). The healthcare sector makes a significant contribution to GHGEs and in line with national legislation in the UK, the NHS has recently committed to achieving net zero emissions by 2050. The management of asthma and COPD largely depends on the prescribing of medications that are delivered through inhalers. In the UK, the use of pressurized metered dose inhalers (pMDIs), which rely on hydrofluorocarbon (HFC) propellants accounts for 3.5% of the NHS’s total carbon footprint. In contrast, dry powder inhalers (DPIs) have a much lower carbon footprint due to the absence of a HFC propellant. Here we review evidence of the impact of inhaler choices across four domains: environmental impact, clinical effectiveness, cost effectiveness and patient preferences. We find that as well as a lower global‐warming potential, DPIs have additional benefits over pMDIs in other domains and should be considered first line where clinically appropriate.

Turning green: the impact of changing to more eco-friendly respiratory healthcare – a carbon and cost analysis of Dutch prescription data

“…Janson et al recommend that ‘the lower carbon footprint of DPIs should be considered alongside other factors when choosing inhaler devices’ 9. In their review, Starup-Hansen et al recommend to update guidelines: ‘guidance should consider the potential benefits of advising DPIs as the device of choice in new diagnoses of asthma and COPD as well as the benefits of switching patients currently using pMDIs to DPIs where clinically appropriate’ 10. These recommendations have been recently adopted in the guidelines ‘Asthma in adults’11 and ‘COPD’12 of the Dutch College of General Practitioners (NHG).…”

Environmental effect of air versus gas tamponade in the management of rhegmatogenous retinal detachment VR surgery: A multicentre study of 3,239 patients

“…Although Ophthalmology accounts for a small portion of CO 2 emissions, changes of various degree across multiple disciplines of medicine will total to significant reductions in our NHS carbon footprint and it is reassuring to see many efforts in this direction [ 30 – 32 ]. Although there are significant environmental savings that can achieved using AT, the net savings compared to other industries are small, and patients’ safety and surgeon preference (and confidence in their surgical technique) must take precedence.…”

Switching to the Dry-Powder Inhaler Easyhaler®: A Narrative Review of the Evidence

“…The carbon footprint of inhaled treatments has come under scrutiny recently, largely due to the greenhouse-gas effect of hydrofluoroalkane propellants used in MDIs [ 27 ]. These propellants are powerful greenhouse gases (from 1500 to 3000 times greater global warming potential than CO 2 [ 28 ]), and so have a disproportionate impact on the carbon footprint of treatment. In the UK for instance, MDIs contribute 13% of the core carbon footprint of the National Health Service (NHS) related to delivery of care, and 3% of the “carbon footprint plus” emissions which the NHS can influence [ 29 ].…”