How Much Does Inhalers for Asthma and COPD Contribute to Carbon Emissions?

A recent study published in the Journal of American Medical Association highlighted the significant environmental impact of metered-dose inhalers (MDIs), which are commonly prescribed for asthma and chronic obstructive pulmonary disease (COPD). These inhalers contain hydrofluorocarbon (HFC) propellants which is a potent greenhouse gases that trap heat in the atmosphere at rates thousands of times more potent than carbon dioxide (CO2). The study emphasizes the urgent need to transition from HFC-containing MDIs to more eco-friendly alternatives, such as dry-powder and soft-mist inhalers.

In England, the carbon emissions from MDIs contribute to an estimated 0.8 million metric tons (MMT) of CO2 equivalent (CO2e) annually. This is comparable to the yearly electricity consumption of 157,885 homes in the United States. The National Health Se

rvice (NHS) actively promoted the switch to propellant-free inhalers to reduce environmental harm in response to these emissions. However, the situation seems to be quite different in the United States.

The U.S. healthcare system is responsible for 550 MMT of CO2e emissions annually, which is much higher than the NHS England’s 30.4 MMT. Despite this large carbon footprint, efforts to address inhaler-related emissions in the U.S. have been slow. One significant barrier is the limited data on the carbon footprint of inhalers prescribed in the country. This gap has hindered informed decision-making and policy shifts toward more sustainable inhaler options.

The study in question sought to fill this data gap by assessing the mean emissions and costs of U.S. brand-name inhalers prescribed to Medicare Part D and Medicaid beneficiaries. Together, these programs represent roughly 40% of the nation’s retail prescription drug spending. This research were able to estimate the total annual emissions and financial impact of these inhalers by analyzing the inhalers used within these programs.

The findings reveal that MDIs prescribed under Medicare Part D and Medicaid are responsible for significant CO2e emissions by contributing notably to the U.S. healthcare sector’s overall carbon footprint. The study further highlights the potential for environmental improvement by switching to dry-powder and soft-mist inhalers, which do not rely on harmful propellants. The cost analysis showed that while propellant-free inhalers may have a higher initial cost, their long-term environmental benefits outweigh the expenses.

Overall, his study calls for a focused effort to address inhaler-related emissions in the U.S., by drawing attention to the potential for policy interventions that encourage the adoption of more sustainable inhaler alternatives. It also illuminated the need for better awareness among clinicians and patients about the environmental impact of their treatment choices. Aligning with global climate goals while maintaining patient care standards could reduce the reliance on HFC-containing inhalers and thereby significantly lower the carbon footprint of the U.S. healthcare system.

Reference:

Tirumalasetty, J., Miller, S. A., Prescott, H. C., DeTata, S., Arroyo, A. C., Wilkinson, A. J. K., & Rabin, A. S. (2024). Greenhouse Gas Emissions and Costs of Inhaler Devices in the US. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2024.15331