The Environmental Impact of Inhalers

Different inhalers have a different carbon footprint compared to others. Here we consider how inhalers could be switched to low carbon alternatives, how you should use them properly and dispose of them correctly to reduce the impact on the environment.

The situation is bad but was even worse before

Originally metered-dose inhalers (MDIs) contained propellants carrying the medication called CFCs. CFCs are so harmful that in the 1980s the Montreal Protocol was signed by many countries to phase out their use. They damaged the ozone layer and were notable greenhouse gases. To replace them nowadays we use HFAs, however, these are still greenhouse gases. This means that your inhaler may, unfortunately, be contributing to climate change.

The scale of the problem

On an individual level using an MDI means you are likely producing between 150kg-400kg of CO2 per year. Roughly 50 million inhalers were issued in England in 2017 of which 70% were MDIs. The different meter-dose inhalers can be estimated to have a different carbon footprint per inhaler:

Flutiform greater than 36 kg CO2
Ventolin greater than 25kg CO2
Fostair less than 20kg CO2
Salamol less than 10kg CO2

Alternatives to MDIs

If the NHS switches 10% of prescribed MDIs to an alternative dry powder inhaler (DPI) not only could it save the NHS over £8 million pounds, according to a recent study published in the BMJ by Cambridge researchers, but substantially reduce carbon footprint by 10-37 times. Equivalent CO2 emissions may be reduced by close to 60 kilotonnes - around 180,000 car journeys from London to Edinburgh and back!

Please note that while you shouldn’t suddenly discontinue your MDI, as part of your regular review with your doctor you could ask about using an alternative inhaler.
Researchers are also looking into newer forms of HFAs such as HFA152a which has a lower carbon footprint than the current HFAs to develop better MDIs. This is important because some groups of patients such as children or the elderly can benefit from MDI use as spacer devices can be attached to them. Mist devices are also another alternative.

Disposal is also important

MDIs have such a high carbon footprint not only due to the release of HFA during their use but also because residual HFA remains in the canisters once your inhaler puffs have run out. So it is really crucial to dispose of your inhaler by returning it to a pharmacy. If everyone in the UK returned their inhalers for 1 year it could save over 500,000 tonnes of CO2 equivalent which is the same as if you were to drive a Volkswagen Golf car around the world nearly 90,000 times! Furthermore do not dispose of your inhaler before it has actually run out.

Make sure your inhaler technique is correct

So far we have assumed that all of the propellant is being utilised to deliver medicine to your lungs. For this to be the case you must ensure you use your inhaler as prescribed. For a typical meter dose inhaler this will consist of the following steps:

First, take the cap off your inhaler
Shake your inhaler
Gently breathe out
Place your lips around the mouthpiece
Press on the inhaler and breathe in slowly and deeply
Hold your breath for up to 10 seconds ideally
Breathe out
Wait a few seconds and repeat the above steps
Once you are finished place the cap on your inhaler

A healthcare professional will usually guide you on this process at least once. If you are feeling a strange taste in your mouth after using your inhaler or your mouth feels fuzzy, it is likely your technique is not correct. It is a common mistake to make but you can easily fix this.

Summary

By using your inhaler correctly, disposing of it properly and considering alternatives to current meter-dose inhalers it is possible to help save the environment.