Asthma Inhalers: Essential for Patients but Harmful to the Environment

Healthcare’s impact on climate change often brings to mind the energy demands of hospitals and mountains of disposable medical waste. Yet, one crucial device for millions suffering from asthma and COPD—nasal inhalers—quietly contributes to worsening the planet’s health.

The Carbon Footprint of Metered-Dose Inhalers

Asthma inhalers rarely feature in conversations about environmental impacts of healthcare, but experts such as Jyothi Tirumalasetty of Stanford University highlight their role as a key focus for emission reductions.

Metered-dose inhalers deliver medication using a propellant gas, mostly hydrofluorocarbons (HFCs), which have a heat-trapping potential far exceeding that of carbon dioxide, significantly fueling climate change.

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In collaboration with Shelie Miller from the University of Michigan, Tirumalasetty examined 2022 Medicare and Medicaid data, showing that inhaler emissions are equivalent to the annual energy use of a city like Milwaukee. Key findings included:

Predominant Emission Source: Nearly 98% of emissions linked to inhalers originated from metered-dose variants.
Economic Trade-offs: Cleaner alternatives, such as dry powder inhalers, though eco-friendlier, are prescribed less often and incur $2.5 billion more in costs despite their reduced emissions.

Previously, chlorofluorocarbons (CFCs) were phased out and replaced by HCFCs. While HCFCs do not deplete the ozone layer, they remain powerful greenhouse gases.

There is potential for propellants with zero emissions, but adopting these new inhalers may raise prices and affect insurance coverage tiers, possibly reducing their immediate availability.

Health and Environmental Safety Issues

HFC-based inhalers are safe for patients since most of the propellant is expelled during use. However, about 30% of propellant remains inside the device after use, posing environmental challenges when disposing of inhalers.

Unlike the UK, which employs closed-loop recycling systems to reclaim these gases for other industries, the United States lacks widespread recycling programs for inhalers, increasing the environmental footprint.