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Green Solutions

Green Respiratory Care

Breathing life into respiratory care

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Inhalers are commonly used for respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD).

 

Metered-dose inhalers (MDI) are pressurized with hydrofluorocarbon (HFC) propellants, which are powerful greenhouse gases. Leakage of the propellant into the atmosphere mostly occur during the patient usage phase, especially when there is poor synchronization of inhalation and medication delivery.

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HFC-134a

100-year GWP

370

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HFC-227ea

100-year GWP

3350

GWP = Global warming potential; 100-year GWP of CO2 is 1

Global warming potential is a measure of the atmospheric lifetime and the radiative efficiency of a gas relative to CO2, which reflects its heat trapping ability. This means releasing 1 unit of HFC-134a has the same global warming effect of releasing 370 units of CO2 into the atmosphere. It's estimated that delivery of 100 doses of MDI is equivalent to 290km car journey.

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Metered-dose inhalers are pressurized with hydrofluorocarbon propellants, which are powerful greenhouse gases

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Hence, effort is placed into better disease control, in order to reduce the need and amount of MDI prescribed. Such measures include promoting smoking cessation and appropriate use of maintenance therapy.

 

Low carbon alternatives to MDI are also available, including dry powder inhalers (DPI), which do not use propellants.

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MDI

carbon footprint per dose

500g

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DPI

carbon footprint per dose

20g

Improper disposal of MDI leads to leakage of residual propellants into the atmosphere. Inhalers can be returned to designated pharmacies, with the plastic and aluminum recycled, or being incinerated to allow thermal degradation of the propellants.

  • Advocate smoking cessation during various patient encounters and provide information on cessation programs and aids

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  • Consider alternatives to metered dose inhalers, such as dry powder inhaler, nebulizer, aqueous mist inhaler

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  • Optimize metered dose inhaler regimen by using combination inhalers, prescribing higher dose per puff

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  • Optimize inhaler technique and spacer use

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  • Responsible disposal of metered dose inhalers, including recycling and incineration

Some practical ideas
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Successful stories

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Reviewing regimen and inhaler technique

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In 2016, National Health Services City and Hackney Clinical Commissioning Group, a general practitioner-led organization, started a pharmacist-led asthma and COPD medicine optimization clinic. Patients noted to have poorly controlled diseases by general practitioners are referred to this clinic. Interventions include encouraging medication adherence, reducing high dose inhaled corticosteroid if deemed to be overprescribed, checking inhaler techniques and encouraging smoking cessation.

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Improved disease control
(QoL, peak flow, night time awakening, reliever inhaler use, exacerbations, hospital admission)

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Improved smoking cessation rate

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Annual saving £215,100 - £230,500 (drug cost, specialist referral, AED attendance, hospital admission)

Recycling inhalers

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GlaxoSmithKline (GSK) launched an inhaler recycling program in 2011-2020, called 'Complete the Cycle'. Inhalers are collected at pharmacies, and transported to recycling sites as part of routine deliveries, reducing unnecessary travel. The plastic and aluminium are recycled and used in new products. Greenhouse gases are collected and used to generate energy. Inhalers produced by companies other than GSK were also recycled.

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CO2 emission saving 

equivalent to taking 8,600 cars off roads

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More than 2 million inhalers recycled

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Ideas and challenges

Is there information on smoking cessation readily available for my patients at my clinic?

 

Can my patient's inhaler regimen be optimized to improve disease control and also minimize greenhouse gas emission?

 

Can a pharmacist-led or nurse-led clinic be started to encourage medication adherence, check inhaler technique, review inhaler regimen, and promote smoking cessation?

Physicians
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Pharmacists

Can we engage pharmaceutical companies to launch an inhaler recycling program?

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