2023-06-23 00:53:59
Of inhalers used in asthma and COPD can be an important source of greenhouse gases and contribute to climate change.
Of therapy and the appliance must chosen according to the needs and characteristics of the patient. Then it is recommended to where possible opt for an appliance with little impact on the climate.
The BCFI now lists the specialties in the Repertory which contain the most polluting gases.
Health risks of climate change
In recent years, we can no longer ignore the problems of climate change. They are part of our daily lives and push us to change our lifestyle.
The medical world has a major role to play in this.
On the one hand, climate change affects human health. According to the World Organization of Family Medicine (WONCA)1 and the Lancet2, climate change has already visible consequences for human health: increase in cardiovascular and respiratory morbidity and mortality, in infectious diseases, in malnutrition and deterioration in mental health (see also the graph below).
The WHO is also calling for urgent action3 to protect our health.
On the other hand, the medical activity An negative impact on the climate. According to the Lancet report ‘Countdown on health and climate change’ was the health sector in 2017 responsible for 4 to 6% of greenhouse gas emissions (approximately 2 gigatons of CO2), mainly due to the supply chain (production, transport and handling of goods and services, including pharmaceuticals)2,4,5.
What can we do at our level to limit that impact?
In this article, we specifically discuss the environmental impact of inhalers used in asthma and COPD.
Impact of inhalers on climate change
The active substance in inhalers can be delivered in different ways.
Bee solutions or suspensions for inhalation in a pressurized aerosol can, the active substance is released in the form of an aerosol created by nebulisation. This atomization is done with the help of drijfgassen of van mechanical energy.
Bee powders for inhalation the aerosol is created by the force of the inhalation of the patient.
The carbon footprint of the different forms of propulsion is as follows, with comparable examples:
2 per inhaler for inhalation powders and mechanical release aerosols (Respimat®)
1-20 kg CO2 per inhaler for metered dose aerosols containing the propellant HFA134a, which corresponds to a journey of 50 to 120 km with a diesel car.
> 20 kg CO2 per inhaler for metered dose aerosols containing the propellant HFA227ea, which corresponds to a journey of 185 km in a diesel car.6,7
Based on that information, it is recommended to prefer powder inhalers or mechanical release devices.
However, the patient’s condition does not always allow a choice. To use powder inhalers correctly, the patient must inhale forcefully. This is not always possible, especially in elderly people or people with impaired respiratory function, or in children under 5 years of age.
In addition, not all bronchodilators and inhaled corticosteroids are available in the most ecological forms.
Table of inhalers according to their ecological impact (situation on May 26, 2023)
2 per inhalator 1-20 kg CO2 per inhalator > 20 kg CO2 per inhalator Kortwerkende beta 2-mimetic (SABA’s) salbutamol Novolizer Salbutamol Airomir Autohaler Ventolin Langwerkende beta 2-mimetic (LABA’s) formoterol Foradil
Formagal
Novolizer Formoterol
Formoair
indacaterol
Onbrez
olodaterol
Striverdi Respimat
salmeterol
Serevent Diskus
Serevent Evohaler
Kortwerkende anticholinergica (SAMA’s)
ipratropium
Atrovent HFA
Langwerkende anticholinergica (LAMA’s)
aclidinium
Bretaris Genuair
glycopyrronium
Seebri Breezhaler
tiotropium
Spiriva Respimat
Spiriva Handihaler
Srivasso Handihaler
umeclidinium
Incruse Ellipta
SAMA + SABA
ipratropium + fenoterol
Duovent HFA
LAMA + LABA
aclidinium + formoterol
Duaklir Genuair
glycopyrronium + indacaterol
Ultibro Breezhaler
tiotropium + olodaterol
Spiolto Respimat
Yanimo Respimat
umeclidinium + vilanterol
Anoro Ellipta
Inhalatiecorticoïden (ICS)
beclometason
Qvar Autohaler
budesonide
Budesonide Easyhaler
Miflonide Breezhaler
Novolizer Budesonide
fluticason
Flixotide Diskus
Flixotide spuitbus onder druk
LABA + ICS
formoterol + budesonide
Airbufo Forspiro
Bufomix Easyhaler
Symbicort
Turbohaler
formoterol + beclometason
Inuvair Nexthaler
Inuvair spuitbus onder druk
formoterol + fluticason
Flutiform
indacaterol + mometason
Atectura Breezhaler
salmeterol + budesonide
Zephirus
salmeterol + fluticason
Aiflusal Forspiro
Flutisamix Easyhaler
Seretide Diskus Flutisacombo
Pressurized seretide aerosol fluticasone + vilanterol Relvar Ellipta LABA + LAMA + ICS formoterol + glycopyrronium + budesonide Trixeo Aerosphere formoterol + glycopyrronium + beclometasone Trimbow Nexthaler Trimbow pressurized aerosol indacaterol + glycopyrronium + mometasone Enerzair Breezhaler
If we want to limit the impact of the treatments used on the climate, we must first of all ensure that the patient’s conditions and symptoms are under control, i.e. that the patient receives a treatment that is appropriate for his condition and that he uses it correctly.
Thereafter can we, if possible, choose the most ecological device.
Conclusion
The medical world must also adapt to the challenges associated with climate change.
From now on, the BCFI will inform in its publications about the climate impact of medicines when relevant data are available. Where possible, we will provide practical tips.
The inhalers used for very frequent conditions have a climate impact that can be limited. In the first place, the patient must receive the appropriate treatment, and as far as possible we can then choose the least polluting device.
Sources
1 Declaration calling for family doctors of the world to act on planetary health. WONCA September 2019.
2 The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet 2021; 397: 129-70.
https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932290-X
3 https://www.who.int/news/item/06-04-2022-who-urges-accelerated-action-to-protect-human-health-and-combat-the-climate-crisis-at-a-time-of-heightened-conflict-and-fragility
4 Decarbonizing healthcare for sustainable care. TSP Health 2021
5 The climate footprint of the health sector. Health Care Without Harm. Green report number 1. September 2019.
6 KISS: Green Inhaler Prescribing. NB Medical Education Feb 2021.
7 Asthma inhalers and climate change. NICE Guidance ng80. Maart 2021.
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