The environmental impact of inhaled therapy: making informed treatment choices.

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 carbon dioxide 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 examine the published data on carbon footprint data for inhalers, providing an analysis of potential implications for treatment decision making and industry initiatives.

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Copyright ©The authors 2022.

Déclaration de conflit d'intérêts

Conflict of interest: A. Woodcock is co-chair of the Montreal Protocol Technology and Economic Assessment Panel, and member of the Medical and Chemical Technical Options Committee; has received compensation for consulting activities from GlaxoSmithKline, Novartis and Sandoz UK; and has received compensation for speaker activities from Novartis, GlaxoSmithKline and Teva. Conflict of interest: K.M. Beeh and/or the institution he represents has in the past 5 years received compensation for services on advisory boards or consulting activities from AstraZeneca, Berlin-Chemie, Boehringer, Chiesi, Elpen, GlaxoSmithKline, Mundipharma, Novartis, Pohl Boskamp, Sanofi and Teva; compensation for speaker activities in scientific meetings supported by AstraZeneca, Berlin-Chemie, Boehringer, Chiesi, Elpen, ERT, GlaxoSmithKline, Novartis, Pfizer, Pohl Boskamp, Sanofi and Teva; compensation for design and performance of clinical trials from AstraZeneca, Boehringer, GlaxoSmithKline, Novartis, Parexel, Pearl Therapeutics, Teva and Sterna. Conflict of interest: H. Sagara has received compensation for speaker activities supported by AstraZeneca, GlaxoSmithKline, Novartis and Sanofi. Conflict of interest: S. Aumônier is employed by ERM, a global sustainability consulting company that undertakes engagements with a wide range of public sector companies, including many in the healthcare sector and including Novartis. Conflict of interest: E. Addo-Yobo is employed by the Kwame Nkrumah University of Science and Technology, in the Dept of Child Health, School of Medicine and Dentistry, and is Honorary Consultant Paediatrician at the Komfo Anokye Teaching Hospital, Kumasi, Ghana with special interest in paediatric asthma and respiratory care and research; has received compensation as a resource person for asthma educational activities supported by AstraZeneca in Ghana. Conflict of interest: J. Khan and/or the institution he represents has received a research grant from NIHR UK for work on Smokeless Tobacco and Campaign for Tobacco Free Kids for a pilot study on looking at smoking policies at restaurants in Karachi, and is a member of the Medical and Chemical Technical Options Committee. Conflict of interest: J. Vestbo has received honoraria for presenting and/or advising from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva. Conflict of interest: H. Tope is employed by Planet Futures, a consulting business providing services to government, industry and other nongovernmental organisations on climate change, ozone-depleting substances and other environmental issues. As an independent expert, she co-chairs the Medical and Chemicals Technical Options Committee, which provides technical and economic advice, including on inhalers, to the Montreal Protocol. The views expressed herein are those of the co-authors and do not represent those of the Medical and Chemicals Technical Options Committee.