Green Inhalers – An Alternative Treatment For Respiratory Health

Many inhalers, used to treat asthma and COPD (chronic obstructive pulmonary disease) contain potent greenhouse gases. Standard metered-dose inhalers use hydrofluoroalkane propellants which are better than the old chlorofluorocarbons that damage the ozone layer but still have 1,000 times the global warming potential of carbon dioxide.

The NHS can save money and reduce its environmental impact by reducing pMDI prescriptions where appropriate and switching to lower carbon devices. This can be done whilst maintaining patient health and wellbeing.

What is a Green Inhaler?

Inhalers are a vital treatment for many people living with respiratory conditions like asthma and COPD. But sadly, they are not without their side-effects – the propellant gases used in standard MDIs are powerful greenhouse gasses. And this has an impact on global warming, which is linked to climate change, and increased air pollution – all of which can worsen lung health.

This is why we are working with Greater Manchester Integrated Care Partnership to raise awareness of greener inhaler alternatives. Green Inhaler use a different kind of propellant, which has a much smaller carbon footprint and does not release greenhouse gases. And they are just as effective in treating symptoms.

The goal of our campaign is to encourage patients to switch from their standard inhaler to a greener option. It’s important to discuss any changes with your GP or nurse, so that the most appropriate medicine can be prescribed for your condition.

MDIs are the most commonly prescribed inhalers, but there are other types of inhaler that can be useful – dry powder inhalers (DPI) are one example. We are urging patients to consider switching to these, as the greener inhalers are just as effective at relieving symptoms and they have the added benefit of not releasing greenhouse gases into the atmosphere.

In addition, the greener inhalers are easier to use than the MDIs, don’t require a spacer and usually have an indicator that lets you know how many doses are remaining – reducing waste. They are also lighter and smaller than the MDIs, so can be carried in a bag or pocket if needed, making them more convenient for many patients.

We have also heard from people who have made the switch to green inhalers about the positive effects it has had on their health and wellbeing. They are also keen to make the point that it is a morally reasonable action, even for those who may not be personally affected by climate change.

The NHS is committed to its target of a net zero carbon footprint, and reducing the amount of MDIs that are used is an important part of this effort. We are working with GSK to develop new propellants which will be more environmentally sustainable.

How do Green Inhalers Work?

There are many different types of inhaler and each one has a unique shape to deliver the medication into your lungs. Typically, pressurised metered dose inhalers (pMDIs) use a propellant gas such as HFC-134a or HFC-227ea to create a fine mist of medicine to inhale through the lungs. These gases have a very high GWP (Global Warming Potential) and are powerful greenhouse gases, so switching to an alternative inhaler that uses a lower GWP gas is an important step we can take as individuals and as a nation to reduce our carbon footprint.

Red and White Inhaler are devices that can be used with the same medications and can be equally as effective as pMDIs, but they have much smaller carbon footprints. Currently, the only widely available green inhaler is a dry powder inhaler. This type of inhaler has a lower GWP than the HFC-134a or HFC-227ea propellants commonly used in pMDIs, but newer technologies are on their way that may have even better GWPs.

Changing inhalers to ones with a lower impact also helps to reduce waste as they are less likely to be misplaced or thrown away by patients. The NHS is working with Asthma+Lung UK to support the delivery of a new patient decision aid that allows people to opt for an environmentally sustainable inhaler, where clinically appropriate, as part of their prescription.

The new decision aid has been piloted at Kidderminster Medical Centre and is showing early successes. The proportion of metered dose inhalers on repeat prescription has fallen significantly, reducing the environmental footprint at this site by more than a third since the start of work.

The decision aid will also remind patients to use their inhaler correctly as errors are common and can impact their disease control, and that they should return their used inhalers to pharmacies for clinically safe disposal or recycling if possible, rather than throwing them away in the household waste as this releases the propellant gases into the environment contributing to climate change. It will also link to a series of videos created by Asthma UK that give simple demonstrations of how to use an inhaler properly.

What are the Benefits of Green Inhalers?

The impact of metered dose inhalers on greenhouse gas emissions is relatively small compared to those from other sectors. Nonetheless, British pharmaceutical manufacturer GSK estimated that inhalers account for 45 percent of its carbon emissions and has been working to reduce the impact. The industry has also developed new, lower-emissions propellants and is experimenting with reusable and refillable devices.

Despite these efforts, there is still an urgent need to switch to greener inhalers. Many current devices contain propellants made of CFCs or HFAs, potent greenhouse gases. There is a range of effective alternatives that do not contain these chemicals and are less damaging to the climate. These include dry powder inhalers and aqueous mist inhalers, which deliver the same medicine to the lungs with significantly lower carbon footprints than MDIs.

Many of these are available now, but not all clinicians know how to prescribe them or patients are not informed about them. To help address this, a decision aid has been created that can be used in conjunction with the NICE asthma guidelines and includes a section about the carbon footprint of different inhalers. This will allow patients and healthcare professionals to choose an inhaler that is clinically appropriate for their needs.

The decision aid also links to a series of short videos that provide simple demonstrations of correct inhaler technique, which is crucial for optimum use and effectiveness. This is an important aspect of patient education as poor technique can lead to a worsening of symptoms.

Another potential benefit of Round Inhaler is their ability to be more cost-competitive than traditional MDIs, which often have a high price tag and are associated with poorer outcomes for patients with COPD and asthma. This could allow NHS trusts to increase the number of patients who have access to these inhalers without increasing overall costs.

Ultimately, however, the decision to make changes to inhalers should be based on clinical equivalence rather than cost. Some patients may argue that it makes no difference whether they receive an MDI or a DPI, but this ignores the fact that the difference is not only in the amount of medication delivered to the lung but also in the amount of greenhouse gases produced in the manufacture and use of the device.

How do I Switch to a Green Inhaler?

Patients with chronic lung diseases like asthma are at risk of increased symptoms as a result of rising global air pollution, allergens and climate change. For these patients, the pressurized metered-dose inhaler is a critical tool to manage their conditions and maintain good health. But the inhalers have a carbon footprint that contributes to climate change, and researchers are exploring how they can reduce these emissions while continuing to effectively treat respiratory diseases like asthma.

Currently, most metered-dose inhalers use hydrofluorocarbons (HFC) to propel the medicine into the lungs, but there are alternatives that do not contain greenhouse gases. The most common alternatives are dry powder inhalers and soft mist inhalers, which are not as effective for all patients, but can be a good alternative for some, especially those who have difficulty using their HFA inhaler.

In addition to switching inhalers, people can reduce their impact on the environment by making sure they are using their current inhaler correctly and returning used inhalers to pharmacies for proper disposal. They can also make a difference by using a dose counter to ensure they don’t run out of medicine before their next prescription, and avoiding throwing away half-full inhalers.

A number of NHS organisations are already taking steps to reduce their carbon footprint with inhalers. For example, a GP practice in Worcestershire realised that it was spending £180,000 on metered-dose inhalers each year and wanted to find an alternative solution. The Wyre Forest Health Partnership (WFHP) team developed, tested and implemented a simple system to reduce their environmental impact.

The team’s approach included updating the local formulary to highlight green inhalers, and using their existing electronic prescribing system to promote respiratory prescribing best practice, and environmental messages to GPs. They also partnered with the charity Kindeva to develop an inhaler that uses lower-carbon steroid powder.

Other NHS organisations have also been exploring how to incorporate sustainability into their work with inhalers, for example East and North Hertfordshire Trust, who have implemented a ‘greener’ asthma template for reviews. They have also incorporated pop-ups into the IT system to flag when a metered dose inhaler is being prescribed and offer clinically appropriate low-carbon alternatives.

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March 15, 2024

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