Traditional metered-dose inhalers squirt medicines into the air in puffs. They typically use a hydrofluoroalkane propellant that produces environmentally harmful greenhouse gases.

What is a Green Inhaler?

Standard inhalers contain powerful global warming gases and just one inhaler emits the same amount of CO2 as driving from Manchester to Blackpool! Switching to a Green inhaler for asthma such as a Dry Powder Inhaler or a MDI with a dose indicator can reduce your carbon footprint. You can also lower your environmental impact by returning used inhalers to pharmacies for clinical incineration rather than putting them out with household waste or kerb side recycling.

Why is this important?

Why is it important to switch to a green inhaler?

For people with chronic lung conditions such as asthma and COPD (chronic obstructive pulmonary disease), inhalers are an essential tool to help them breathe. But these little boot-shaped inhalers have a dark side: each puff releases a potent greenhouse gas called hydrofluorocarbon (HFC) 134a. This HFC is 1,430 to 3,000 times more powerful than carbon dioxide, and it contributes to global warming by trapping heat in the atmosphere. This warmer climate can lead to more fires, more air pollution and longer allergy seasons. So, the more inhalers that are used, the worse the impact on our environment is.

Many respiratory patients use metered dose inhalers (MDIs) and may not realise that their MDIs have a high carbon footprint. However, switching to DPIs and SMIs (dry powder inhalers and soft mist inhalers) with no HFC 134a propellant has a much lower carbon footprint. This is because MDIs contain HFC 134a which is slowly released from the inhaler into the atmosphere and is then trapped by the ozone layer, whereas DPIs and SMIs have no HFC 134a propellant.

A recent study published in BMJ Open showed that, if GPs switch patients from MDIs to DPIs and SMIs where appropriate, the NHS could save between 150 and 400kg of CO2 per year. This is equivalent to taking up wall insulation, recycling more or becoming vegetarian.

While this research is an important step forward, there are still barriers to the switchover from HFA inhalers to greener devices. One of the biggest is the cost of DPIs and SMIs compared to MDIs.

Patients also need to be supported to make the switchover. It is critical that doctors, nurses and pharmacists have access to accurate information about the environmental impact of inhalers so they can pass this on to their patients.

As a patient, you can ask your GP about this at your next respiratory review appointment. Your GP will want to know how you are managing your symptoms and what’s working or not, so they can provide you with the best care. Then, you can discuss how a Round Purple Inhaler could benefit you.

How can I switch to a green inhaler?

Some people with breathing conditions such as asthma need an inhaler to help manage their symptoms. But these often contain propellant gases that could contribute to climate change. Inhalers with the smallest carbon footprint would be better for the environment and also less expensive to manufacture. But patients and healthcare professionals need to discuss the best options for their individual needs with their GP. The Scottish Government’s 'Quality Prescribing for Respiratory Illness 2024 to 2027 -- draft guidance' emphasises that the best approach is a person-centred one and does not recommend a blanket switch from metered dose inhalers (MDI) which use greenhouse gas-containing propellants to dry powder inhalers (DPI).

The current most popular inhaler in Greater Manchester, the blue Ventolin Evohaler, has a carbon footprint of around 28kg CO2e per device, the equivalent of driving a car for 180,000 return trips between London and Edinburgh. Replacing these devices with greener ones could make a significant contribution to reducing carbon emissions, according to researchers from the University of Cambridge. But they stress that wider clinical considerations – including ensuring the patient has an accurate diagnosis and is having regular respiratory reviews and using their inhaler correctly – should be taken into account.

Asthma sufferers can also reduce their carbon footprint by switching to a DPI for maintenance treatment rather than an MDI for reliever use. This has a lower carbon footprint and reduces the need for a spacer. It can also be easier to use and will usually have a counter, so that the user knows how many doses are left, which reduces waste.

A Green Inhaler website was launched by two Scottish asthmatics, Dr Alexander Wilkinson and Laura Wilson, to support people who want to discuss their inhaler choice with their GP and are concerned about its impact on the environment. The specialitymedz site explains why greener inhalers are better and offers tips for patients on how to use their new device. It also provides a list of local suppliers. Patients can also take their used inhalers to recycling schemes, which are able to reuse some of the gases they release, for safe disposal.

What are the benefits of switching to a green inhaler?

A new study has found that the carbon footprint of 100 puffs from traditional aerosol metered-dose inhalers (pMDIs) is the same as a 290 kilometre car drive. This is due to the fluorinated gases used as propellants in pMDIs to help deliver medication into the airways. Thankfully, effective alternatives exist that can be clinically just as good. In fact, dry powder inhalers (DPIs) and soft mist inhalers (SMIs) have a lower carbon footprint than pMDIs as they do not use any greenhouse gases.

The NHS is supportive of patients changing to environmentally friendly inhalers if it’s clinically appropriate. The move to greener inhalers is a great opportunity for GPs and NHS staff to engage with their patients about their environmental impact and how they can make positive changes.

This work can be further extended to support patient choice, as well as exploring the principle of environmental prescribing – the idea that healthcare professionals should promote the lowest cost treatments which also improve outcomes and are more sustainable.

A recent study from Asthma+Lung UK found that most people with asthma would like to see their doctor consider the environmental impact of the medications they prescribe. But this needs to happen in a holistic way. We need to be able to provide data on the carbon footprint of different inhalers, so that patients can take this into consideration alongside their health and well-being when deciding what treatment is best for them.

One approach could be to offer inhaler recycling schemes. These schemes have been successful in other countries where there is a strong focus on climate change mitigation. But the best option is to educate GPs, nurses and pharmacists about the benefits of Round Inhaler, and encourage them to switch where it’s clinically appropriate.

Two members of the pharmacy team in a Swansea GP surgery took this on board and won a health board sustainability competition with their project to reduce greenhouse gas emissions from inhalers. They ran a 10-week project to educate patients about the environmental impact of their inhalers, and how they can swap out MDIs for DPIs where that’s clinically appropriate. Their efforts saw a 79 per cent reduction in carbon dioxide emissions from inhalers throughout the project.