Abstract
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 CO2 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 will examine the published data on carbon footprint data for inhalers, providing an analysis of potential implications for treatment decision making and industry initiatives.
Footnotes
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Conflicts of interest: Prof Ashley Woodcock is Co-chair of the Montreal Protocol Technology and Economic Assessment Panel, and member of the Medical and Chemical Technical Options Committee have received compensation for consulting activities from GlaxoSmithKline, Novartis, and Sandoz UK; compensation for speaker activities from Novartis, GlaxoSmithKline, and Teva.
Conflicts of interest: Dr Kai-Michael Beeh and/or the institution he represents have in the past 5 years received compensation for services on advisory boards or consulting activities from AstraZeneca, Berlin Chemie, Boehringer, Chiesi, Elpen, GSK, Mundipharma, Novartis, Pohl Boskamp, Sanofi, and Teva; compensation for speaker activities in scientific meetings supported by AstraZeneca, Berlin Chemie, Boehringer, Chiesi, Elpen, ERT, GSK, Novartis, Pfizer, Pohl Boskamp, Sanofi and Teva; compensation for design and performance of clinical trials from AstraZeneca, Boehringer, GSK, Novartis, Parexel, Pearl Therapeutics, Teva and, sterna.
Conflicts of interest: Prof Hironori Sagara receives compensation for speaker activities in lectures supported by AstraZeneca, GSK, Novartis, and Sanofi.
Conflicts of interest: Simon 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.
Conflicts of interest: Prof Emmanuel Addo-Yobo is employed by the Kwame Nkrumah University of Science and Technology, in the Department 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 resource person for asthma educational activities supported by AstraZeneca in Ghana.
Conflicts of interest: Prof Javaid Khan and/or the institution he represents have received 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.
Conflicts of interest: Jørgen Vestbo has received honoraria for presenting and/or advising from AstraZeneca, Boehringer-Ingelheim, Chiesi, GSK, Novartis and Teva.
Conflicts of interest: Helen Tope is employed by Planet Futures, a consulting business providing services to government, industry and other non-governmental 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.
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- Received July 28, 2021.
- Accepted November 22, 2021.
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