A Spanish study aiming to address the environmental impact of inhalers has highlighted the importance of aligning clinical need and sustainability criteria into prescribing practices.
Focusing on reducing the high carbon footprint of pressurised metered-dose inhalers (pMDIs), the researchers developed a framework promoting the use of eco-friendly alternatives like dry powder inhalers (DPIs) and soft mist inhalers.
pMDIs contribute notably to the carbon footprint of medicines and healthcare, with two puffs of a hydrofluoroalkane (HFA) propelled pMDI being equivalent to driving 2km by car. Therefore, the study’s aim was to create a framework to reduce this environmental burden by implementing greener prescription practices without compromising patients’ health.
The mixed methods research first involved the formation of a multidisciplinary working group, including hospital pharmacists, pulmonologists and academics. A comprehensive database was then developed, incorporating the carbon footprint and other environmental data of inhalers marketed in Spain.
A key element to this was creating a decision-making algorithm integrating both clinical and environmental criteria, allowing healthcare professionals to consider sustainable alternative inhaler types.
The study revealed ‘significant variability in inhaler carbon footprint, with pMDIs showing the highest emissions due to HFA propellants’, the researchers said.
Scenario projections showed that a 10% shift from pMDIs to DPIs could reduce CO2 emissions by up to 40,000 tonnes annually. A 50% shift could save as much as 200,000 tonnes.
The authors concluded that incorporating environmental criteria into inhaler prescribing decisions could substantially reduce the healthcare sector’s carbon footprint and that ‘the decision-making algorithm developed in this study offers a practical tool’ for achieving this.
The study’s findings also highlighted the importance of involving patients in the decision-making process, empowering them to consider the environmental implications of their treatment choices.
Moving forward, the researchers suggested further work was needed to refine the decision-making algorithm and explore its application in other healthcare settings and countries. Additional studies are also required to evaluate the long-term effects of greener inhaler prescribing practices on both patient health and environmental outcomes.
Policymakers should consider incorporating these findings into national healthcare guidelines to promote sustainable prescribing on a broader scale, the researchers added.
Reference
Garin N, Zarate-Tamames B, Lertxundi U, et al. The environmental impact of inhalers: a framework for sustainable prescription practices in Spain. European Journal of Hospital Pharmacy, January 2025. doi: 10.1136/ejhpharm-2024-004402.
