Summary of methodology used in studies on the carbon footprint of inhalers
| Carbon Trust [26] | Jeswani and Azapagic [10] | Panigone et al. [27] | Hänsel et al. [28] | Orion Pharma [29, 30] | Aumônier et al. [31] | |
| Inhaler and drug combination(s) studied (pack size) | • FF/VI 92/22 μg DPI (Relvar Ellipta; 30-day) • SAL/FP 50/500 μg Accuhaler DPI (Diskus; 30-day) • SAL/FP 25/250 μg pMDI (30-day) | Inhaler devices only, API not considered: • DPI (Diskus) (60-dose) • HFC-134a pMDI (100-dose/200 act) • HFC-227ea pMDI (60-dose/120 act) • HFC-152a pMDI (100-dose/200 act) | • FORM/BDP NEXThaler 6/100 μg DPI (120-dose)# • FORM/BDP 6/100 μg pMDI (120-dose)# | • TIO Respimat SMI (both disposable and reusable; 60 act per month) • IB/FEN Respimat SMI (120 act per month) • IB/FEN HFC pMDI (200 act per month) • IB HFC pMDI (200 act per month) | Easyhaler DPI: • BUD/FORM 160/4.5 µg (120-dose) • SAL/FP 50/250 µg (60-dose) • SALB 100 µg (200-dose) • FORM 12 µg (120-dose) | Breezhaler DPI: • IND/GLY/MF (30-day)+sensor • IND/GLY/MF (30-day) • IND/GLY/MF (90-day) • IND/MF (30-day) |
| Method and standard(s) applied | PAS 2050, GHG Protocol Product Standard Sector Guidance [25], Carbon Trust Footprint Expert tool | ISO 14040 and ISO 14044 (multiple environmental impacts appraised) [32, 33] | ISO 14067 and GHG Protocol Product Standard Sector Guidance [2, 34] | IPCC Fifth Assessment Report on Climate Change, GHG Protocol Product Life Cycle Accounting and Reporting Standard and Standard Sector Guidance [25, 34, 35] | Analysis conducted by Carbon Footprint Ltd in accordance with ISO 14067 (multiple environmental impacts appraised) [2] | Streamlined LCA completed in accordance with the GHG Protocol Product Accounting and Reporting Standard using Sector Guidance for Pharmaceuticals and Medical Devices [25, 34] |
| Assurance/certification | Individual product carbon footprints certified by Carbon Trust as compliant with the above standards; certification report published | None | Third party (not named); the calculation tool/procedure (CF-S) is stated as certified; product footprints reported as being certified to the above standards | Not disclosed | Analysis conducted by Carbon Footprint Ltd (ISO 14001:2015 and 9001:2015 certified) | Critically reviewed/verified by third party (representative from Resource and Waste Solutions); certification report available |
| Life cycle stages included | ||||||
| Raw material extraction | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Production of device | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Production of API | ✓ | ✗ | ✓ | ✓ | ✓ | ✓ |
| Production of final product | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Packaging | ✓ | ✗ | ✓ | ✓ | ✓ | ✓ |
| Distribution and storage | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Pharmacy/retail | ✗ | ✗ | ✗ | Not stated | Not stated | ✗ |
| Patient travel | Not stated | ✗ | Not stated | Not stated | Not stated | ✗ |
| Patient use | ✓ | ✓ | ✓ | ✓ | Not stated | ✗ |
| End-of-life disposal | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
SAL: salmeterol; FP: fluticasone propionate; pMDI: pressurised metered-dose inhaler; FF: fluticasone furoate; VI: vilanterol; DPI: dry powder inhaler; API: active pharmaceutical ingredient; HFC: hydrofluorocarbon; act: actuations; FORM: formoterol; BDP: beclometasone dipropionate; TIO: tiotropium bromide; SMI: soft mist inhaler; IB: ipratropium bromide; FEN: fenoterol hydrobromide; BUD: budesonide; SALB: salbutamol; IND: indacaterol acetate; GLY: glycopyrronium bromide; MF: mometasone furoate; PAS: Publicly Available Specification; GHG: Greenhouse Gas; ISO: International Organization for Standardization; IPCC: Intergovernmental Panel on Climate Change; LCA: life cycle assessment. #: other drug/device combinations investigated in this study have not been discussed here.