Reducing carbon footprint of inhalers: analysis of climate and clinical implications of different scenarios in five European countries

Abstract

BackgroundInhaled therapies are key components of asthma and chronic obstructive pulmonary disease (COPD) treatments. Although the use of pressurised metered-dose inhalers (pMDIs) accounts for <0.1% of global greenhouse gas emissions, their contribution to global warming has been debated and efforts are underway to reduce the carbon footprint of pMDIs. Our aim was to establish the extent to which different scenarios led to reductions in greenhouse gas emissions associated with inhaler use, and their clinical implications.MethodsWe conducted a series of scenario analyses using asthma and COPD inhaler usage data from 2019 to model carbon dioxide equivalent (CO2e) emissions reductions over a 10-year period (2020–2030) in the UK, Italy, France, Germany and Spain: switching propellant-driven pMDIs for propellant-free dry-powder inhalers (DPIs)/soft mist inhalers (SMIs); transitioning to low global warming potential (GWP) propellant (hydrofluoroalkane (HFA)-152a) pMDIs; reducing short-acting β2-agonist (SABA) use; and inhaler recycling.ResultsTransition to low-GWP pMDIs and forced switching to DPI/SMIs (excluding SABA inhalers) would reduce annual CO2e emissions by 68%–84% and 64%–71%, respectively, but with different clinical implications. Emission reductions would be greatest (82%–89%) with transition of both maintenance and SABA inhalers to low-GWP propellant. Only minimising SABA inhaler use would reduce CO2e emissions by 17%–48%. Although significant greenhouse gas emission reductions would be achieved with high rates of end-of-life recycling (81%–87% of the inhalers), transition to a low-GWP propellant would still result in greater reductions.ConclusionsWhile the absolute contribution of pMDIs to global warming is very small, substantial reductions in the carbon footprint of pMDIs can be achieved with transition to low-GWP propellant (HFA-152a) inhalers. This approach outperforms the substitution of pMDIs with DPI/SMIs while preserving patient access and choice, which are essential for optimising treatment and outcomes. These findings require confirmation in independent studies.

Environmental impact of inhaler devices on respiratory care: a narrative review

“…(16) Na prática clínica, essas taxas de reciclagem podem ser muito difíceis de ser alcançadas e exigem investimentos significativos e mudanças comportamentais; no entanto, se os esquemas de reciclagem fossem lançados agora, reduções ocorreriam em curto prazo. (9) A reciclagem de inaladores em locais específicos como farmácias, ao contrário do descarte em aterros, deve possibilitar a reutilização de componentes de plástico ou alumínio e reduzir a emissão de CO 2 . (21) O descarte inadequado de dispositivos IPD com doses não utilizadas é especialmente preocupante, pois além de aumentar a carga de prescrição, os dispositivos em desuso continuam liberando GEE, que persistem na atmosfera por até 50 anos.…”

“…(21) O descarte inadequado de dispositivos IPD com doses não utilizadas é especialmente preocupante, pois além de aumentar a carga de prescrição, os dispositivos em desuso continuam liberando GEE, que persistem na atmosfera por até 50 anos. (9,17) Em uma declaração de posicionamento sobre meio ambiente e saúde pulmonar, (21) a British Thoracic Society destacou a importância de informar os pacientes sobre como evitar o descarte de inaladores em aterros sanitários com as seguintes recomendações:…”

“…(8) Três classes principais de dispositivos de terapia inalatória estão disponíveis para pacientes com asma e DPOC: IPD, inaladores de pó (IP) e inaladores de névoa suave (INS). (9) A pegada de carbono desses dispositivos inaladores é distinta, sendo mais intensa com os IDP que com os IP e INS. Isso significa que novas abordagens devem ser consideradas para equilibrar as metas ambientais com a saúde e o bem-estar do paciente, mantendo uma gama diversificada de opções terapêuticas para pacientes e médicos.…”

Inhalers and the Environment: Pollution, Plastics and Policy

“…The environmental effect of DPIs should also be considered, even though they do not contain F-gases, they can have a greater impact on marine and human toxicity 15 . However, when evaluating the best-case scenario for switching inhalers, the global reduction in emissions is most profound when maintenance and reliever pMDIs transition to the use of low GWP propellant (HFA-152a) 26 .…”

Reducing carbon footprint by switching to reusable soft-mist inhalers

“…[10] No such comparison has been made regarding the carbon footprint of switching pMDIs or DPIs for SMIs, with one study grouping DPIs and SMIs together for analysis. [11] As the carbon footprint is different for every inhaler, robust quantification is needed to assess the current impact of the three types of inhaler devices. This study aimed to compare the carbon footprint, measured in terms of CO 2 e emissions, of switching the COPD patient population to the SMI, Respimat Reusable.…”