How Green Is My Agenda

Climate change is one of the biggest threats we face.

We’re already seeing the impact: rising global temperatures, extreme weather, melting ice caps, and much more. These changes are affecting our planet, and the way we live including what we eat, how we grow food, and even the air we breathe is being shaped by climate change.

But it’s not only industrial activity that plays a part. The medicines prescribed, specifically some of the most used treatments for chronic conditions such as asthma and COPD can have a surprising environmental impact, this includes some inhalers, particularly pressurised metred dose inhalers (pMDI) which use greenhouse gases (GHGs) as propellants and carry a higher carbon footprint compared to other inhalers.^[1]

After reading this article you can:

• reflect on your own prescribing habits and their environmental impact
• consider practical ways we can make a difference
• consider how to balance patient centred care with lower carbon alternatives.

The green agenda

The green agenda is about policies, initiatives, and practices that focus on environmental sustainability and seek to address the effects of climate change. That means cleaner energy, greener transport, better waste management and innovation in how we deliver healthcare.^[2] Essentially, it’s about creating a more environmentally responsible and sustainable future whilst recognising how our day-to-day choices can have an impact on the planet.

Our response to reducing GHGs in terms of our most used inhaler the pMDI may compromise our patients, their health and in so doing increase morbidity, thus impacting in terms of health care utilisation and ultimately, the environment.^[3]

The NHS has committed to reducing GHG emissions from inhalers, as part of the commitment to Net Zero, balancing the emissions we produce with those we remove.^[4] Reducing emissions from inhalers is one of the main commitments. How can we do this:

Guidance

BTS/NICE SIGN have guidance on using inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) combinations in a maintenance and reliver which can reduce reliance on short-acting beta agnostics (SABA).^[5]

SABA inhalers make up the majority of inhaler related emissions in the UK.^[6] Over 200,000 asthma patients are potentially overusing SABA, with an average of 6.5 prescriptions per year – accounting for around 83% of all SABA prescriptions. Across the UK asthma population, this amounts to over 9 million SABA prescriptions, generating an estimated 250,000 tonnes of CO₂ annually.^[7]

Device choice

If a patient can effectively use a dry powder inhaler (DPI), switching from a pMDI can significantly lower their carbon footprint.^[8] However, no one device suits all patients. The choice of inhaler should be tailored to the individuals needs based on access, the prescriber’s clinical assessment and the patient’s ability and preference.^[9]

Recycling

More than 60 million inhalers are prescribed each year in the UK with a very high proportion ending up in landfill.^[10],[11] Encouraging patients to return used inhalers to pharmacies for proper disposal helps reduce the impact of inhalers on the environment as well as raising awareness about schemes such as Take AIR (Action for Inhaler Recycling).

Climate change is everyone’s responsibility but as healthcare professionals we face unique challenges. Alongside our duty to care for patients, we must ensure our decisions are rational and considered. We can help minimise the environmental impact of inhalers through appropriate prescribing, reducing SABA use and prescribing combination inhalers. The ‘greenest inhaler’ is ultimately the one that the patient can use correctly and gain maximum benefit while also reducing their carbon footprint.

Any advice given and opinions expressed in this article are those of the author and do not reflect the view of Chiesi Limited (Chiesi).  All content in this article is for informational and educational purposes only.  Although Chiesi strives to always provide accurate information, it is not responsible for and does not verify for accuracy any of the information contained within.

[1] National Institute for Health and Care Excellence (NIC). Asthma inhalers and climate change. Available at: https://www.nice.org.uk/guidance/ng245/resources/patient-decision-aid-on-asthma-inhalers-and-climate-change-bts-nice-sign-pdf-13558151917

[2] Climate Change Committee. The Seventh Carbon Budget. Available at: https://www.theccc.org.uk/publication/the-seventh-carbon-budget/

[3] Primary Care Respiratory Society. “Blanket” switching of inhaler types. Why is this a bad idea? Available at: https://www.pcrs-uk.org/sites/default/files/resource/Blanket_switching_inhaler_types_2025.pdf

[4] NHS England. Delivering a net zero NHS. Available at: https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/

[5] Asthma pathway (BTS, NICE, SIGN). Available at: https://www.nice.org.uk/guidance/ng244

[6] Alzaabi A, Bell JP, Montero-Arias F et al. Adv Ther. 2023; 40(11): 4836-4856

[7] Wilkinson AJK, Menzies-Gow A, Sawyer M et al. Thorax. 2021; 76(Suppl1):A19

[8] Woodcock A, Janson C, Rees J et al. Thorax. 2022; 77(12): 1187-1192

[9] Amin AN, Ganapathy V. Pub Med. 2017; 12

[10] NHS England. Delivering high quality, low carbon respiratory care. Available at: https://www.england.nhs.uk/greenernhs/2023/02/blog-delivering-high-qaulity-low-carbon-respiratory-care/

[11] Environmental Audit Committee. UK Progress on reducing F-gas emissions: Fifth report of session 2017-19. Available at: https://publications.parliament.uk/pa/cm201719/cmselect/cmenvaud/469/469.pdf