Sustainable respiratory care is emerging as a critical frontier in healthcare, where the mission to improve lives must now align with the urgent need to reduce carbon emissions. The climate crisis is also a health crisis, and the respiratory care sector—particularly inhaler production—faces a unique challenge: can it cut its carbon footprint without compromising patient outcomes?
Maria Paola Chiesi, chair of the board for global biopharmaceutical company Chiesi, argues that healthcare’s mission is fundamentally contradicted when pharmaceutical practices contribute to climate change. Research from the University of Michigan Medical School shows that pollution harms not only lung health but also cardiovascular and brain health. This underscores the need for sustainable respiratory care that addresses both patient needs and environmental impact.
The Environmental Impact of Inhalers
Pressurised metered-dose inhalers (pMDIs) are essential for treating chronic lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, the propellant used to deliver medication—a pressurised liquefied gas—has significant environmental implications. Until the 1990s, pMDIs used chlorofluorocarbons (CFCs), which deplete the ozone layer. When CFCs were phased out, they were replaced with hydrofluoroalkane (HFA) propellants, which eliminated ozone risk but were later found to contribute to global warming.
Chiesi faced a pivotal choice: switch to a more sustainable propellant or supply only dry powder inhalers (DPIs). The company opted to invest in a novel propellant with a much lower global warming potential, demonstrating that sustainable respiratory care is achievable without sacrificing efficacy.
Comparing Inhaler Options for Sustainability
Understanding the carbon footprint of different inhaler types is crucial for healthcare providers and patients. The table below compares key environmental and clinical factors.

| Inhaler Type | Propellant | Global Warming Potential (GWP) | Patient Suitability |
|---|---|---|---|
| CFC pMDI (historical) | Chlorofluorocarbons | High (ozone-depleting) | Effective but phased out |
| HFA pMDI (standard) | Hydrofluoroalkane | High (GWP 1000-3000) | Widely used, effective |
| HFA pMDI (low-GWP) | Novel HFA-152a | Low (GWP ~150) | Similar efficacy, requires training |
| Dry Powder Inhaler (DPI) | None (breath-actuated) | Very low | Requires sufficient inspiratory flow |
Switching to low-GWP propellants or DPIs can drastically reduce the carbon footprint of respiratory care. However, patient suitability varies; DPIs may not be appropriate for young children or those with severe airflow limitation.
Strategies for Sustainable Respiratory Care
Achieving sustainability without compromising patient care requires a multifaceted approach. Key strategies include:
- Propellant innovation: Investing in low-GWP propellants like HFA-152a, which maintains efficacy while reducing environmental impact.
- Patient education: Training patients on proper inhaler technique to minimize waste and ensure optimal disease control.
- Recycling programs: Implementing inhaler recycling schemes to safely dispose of propellants and plastics.
- Telehealth and remote monitoring: Reducing travel-related emissions through virtual consultations and remote monitoring of lung function.
- Green prescribing: Encouraging healthcare providers to consider environmental impact when selecting inhalers, where clinically appropriate.
These measures can collectively lower the carbon footprint of respiratory care while maintaining or even improving patient outcomes.
Balancing Patient Needs and Environmental Responsibility
The transition to sustainable respiratory care is not without challenges. Some patients rely on pMDIs for immediate relief and cannot switch to DPIs due to technique or flow limitations. Therefore, a personalized approach is essential. Healthcare providers must weigh the clinical benefits against environmental impact, ensuring that no patient is disadvantaged.
Chiesi’s commitment to developing a low-GWP propellant exemplifies how industry can drive change. Regulatory bodies and health systems also play a role by incentivizing green practices and supporting research into sustainable alternatives.
FAQ
Can sustainable inhalers effectively treat asthma and COPD?
Yes, low-GWP propellants and dry powder inhalers are clinically effective for most patients. However, individual suitability depends on factors like age, inspiratory flow, and disease severity. Healthcare providers should assess each patient to ensure optimal treatment.
What is the carbon footprint of a typical inhaler?
Standard HFA pMDIs have a carbon footprint equivalent to 10-30 kg CO2e per inhaler, largely due to the propellant. Low-GWP alternatives can reduce this by up to 90%, and DPIs have a minimal footprint.
How can healthcare systems encourage sustainable respiratory care?
Healthcare systems can incentivize green prescribing, support inhaler recycling programs, invest in telehealth, and promote research into low-carbon alternatives. Education and training for providers and patients are also key.
Are there any drawbacks to switching to dry powder inhalers?
DPIs require patients to generate sufficient inspiratory flow, which may be challenging for young children, the elderly, or those with severe airflow obstruction. They also require proper technique and may not be suitable for all patients.
Sustainable respiratory care is not just an environmental imperative but also an opportunity to improve patient outcomes through innovation. By embracing low-carbon technologies and smart practices, the healthcare sector can propel change without compromising the quality of care.
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