Time to talk about inhalers and climate change?

Last October the NHS announced a carbon footprint target of net zero by 2040. Inhalers, for conditions like asthma and chronic obstructive pulmonary disease, were identified as a priority because more than 10% of the NHS carbon footprint is from inhalers.  This is because the commonest inhaler devices we use, metered dose inhalers, contain high carbon footprint hydrofluorocarbon propellant gases. These are safe to use but are very bad for climate change. In the UK we use many more metered dose inhalers than low carbon dry powder or soft mist inhalers. But it doesn’t have to be this way. In many European countries they use far more dry powder inhalers. Sweden only uses about 13% metered dose inhalers. Unfortunately, in Cambridgeshire we have one of the highest proportion of metered dose inhalers in England.

For a long time, this discussion has been largely kept away from the public for fear that it risks blaming individuals or even worse that people might stop using their treatment, risking their lives. It is critically important that people who use inhalers keep using their treatment. Any changes to treatment should be discussed with their doctor or nurse or pharmacist so that they are done safely.

The good news is that there are many things which can be done to reduce the environmental footprint of inhalers. One of the most important things to do is to try to get really good disease control. This is good for the environment and great for health. One sign of insufficient control of asthma is if more than 3 reliever inhalers (usually blue Salbutamol inhalers) are being used a year. GPs, respiratory consultants, or specialist nurses can advise on how to improve disease control, often by changes to preventer inhalers which are used regularly.

Many people, but not all, will be able to change to dry powder inhalers. These have a much lower carbon footprint. For people who can’t, or don’t want to, use low carbon inhalers it may still be possible to significantly lower the carbon footprint of their inhalers by switching to other metered dose inhalers or changing dosing regimes.  Another helpful change is to always return used or unwanted inhalers to the pharmacy rather than putting them in the bin.

If you use an inhaler and want to reduce the environmental impact of your care the best thing to do is discuss this issue at your next review at your GP surgery or respiratory clinic. With more awareness and an open non-judgmental collaborative dialogue between clinicians and patients hopefully we can improve health outcomes and minimize the carbon footprint of the NHS saving lives locally and globally. 

By Dr James Smith, GP and Public Health Consultant, for Carbon Neutral Cambridge