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Environment & Sustainability

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Minimising exacerbations by optimising your patient’s asthma control, and choosing inhaler devices with lower carbon footprints where clinically appropriate, can make a difference and help the NHS reach its net zero target.1-5

The impact of pressurised inhalers on our carbon footprint

According to NHS England, NHS carbon emissions are currently equivalent to 4% of England’s total carbon footprint.1 Its ambition for the emissions that it controls directly is to achieve net zero by 2040, with an aim to reach an 80% reduction by 2028 to 2032.

Medicines account for 25% of emissions within the NHS and inhalers commonly used for asthma and COPD account for an estimated 3% of this.1

The majority of the inhaler emissions come from the propellant in metered-dose inhalers (pMDIs).1,2 In the 1990s, the propellant in pMDIs was changed from

chlorofluorocarbons (CFCs) to hydrofluorocarbons (HFCs). HFCs are not ozone

depleting, but they are potent greenhouse gases.2 A study in 2011 showed that pMDIs account for around 70% of inhalers prescribed in the UK.3

Dry Powder inhalers (DPIs) such as WockAIR® are an alternative to pMDIs with a much lower carbon footprint.3

Carbon footprints of different types of inhaler showing carbon dioxide equivalent (CO2e) in kilograms (kg) Adapted from NICE patient decision tool6

Learn more about how to reduce exacerbation risk with WockAIR®

The British Thoracic Society issued a statement in 2020 recommending the following:

Where a new class of inhaler is commenced, this is a Dry Powder Inhaler (DPI).

Where patients are using several classes of inhalers and poor inhaler technique is identified with one device, that the DPI class is prioritised if the patient is able to use these Similarly, future and additional inhalers would ideally also be DPIs.

During all respiratory reviews, prescribers recommend low carbon alternatives to patients currently using Pressured Metered Dose Inhalers (pMDIs), where patients are able to use these safely.

NICE has produced a decision tool6 for patients which helps them to consider carbon footprint when discussing treatment approaches and inhaler devices with their health professionals. It shows the carbon footprint of the various device types compared to car journeys and shows how DPIs compare to pMDIs in terms of carbon footprint.

Adverse events should be reported. Reporting forms and information can be found at: https://yellowcard.mhra.gov.uk/

Adverse events should also be reported to Wockhardt UK. Please contact us or email us at drug.safety@wockhardt.co.uk

REFERENCES

1. Delivering a Net Zero National Health NHS England 2022

2. Janson C, Henderson R, Lofdahl M et al. Carbon footprint impact of the choice of inhalers for asthma and COPD Thorax 2020;75:82–84

3. Lavorini_F, Corrigan CJ, Barnes PJ et Retail sales of inhalation devices in European countries: So much for a global policy. Respir Med 2011;105:1099- 1103.

4. Liang K, Yao JA, Hui P et Climate impact of inhaler therapy in the Fraser Health region, 2016–2021 BC Medical Journal vol. 65 no. 4 | May 2023

5. Kponee-Shoveina K, Marvelb J, Ishikawa R et Carbon footprint and associated costs of asthma exacerbation care among UK adults. J Med Econ 2022: 25 (1) 524–531

6. NICE Inhalers for asthma patient decision aid Available at https://www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma- patient-decision-aid-pdf-6727144573 Accessed March 2024

ABBREVIATIONS

pMDI- pressurised metered dose inhaler; COPD- chronic obstructive pulmonary disease; CFC- chlorofluorocarbons; HFC – hydrofluorocarbons; DPI- dry powder inhaler; CO2 – carbon dioxide

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