The Air We Share: Guiding Inhaler Selection Today for a Sustainable Tomorrow

Abstract

Climate change is currently the greatest global health threat. As the planet experiences rising temperatures due to global warming, widespread health impacts are emerging, including extreme weather events, food insecurity due to droughts, and forced relocation of populations. From a respiratory health perspective, patients with lung disease experience negative health consequences due to high temperatures, risks from heat-related illnesses, exposure to wildfire smoke that causes poor air quality, and increased severity and duration of pollen seasons. The resulting health consequences contribute to increased use of healthcare services, which in turn generate their own contributions to healthcare pollution, thus further worsening the climate crisis.

In fact, the health sector contributes more than 5.2% of net global greenhouse gas emissions. In Canada, healthcare activities are responsible for 4.6% of the country’s total greenhouse gas emissions, placing Canada’s healthcare system among the top four emitters per capita by country. In terms of the contributions of various healthcare sectors to greenhouse gas emissions, England’s National Health Service (NHS) demonstrated that anesthetic gases and metered dose inhalers (MDIs) play a significant role; MDIs alone contribute to 3.1% of the NHS’s total healthcare emissions. MDIs rely on hydrofluorocarbon (HFC) propellants to deliver medication, which act as potent greenhouse gases when released into the atmosphere. Depending on the formulation, one aerosol inhaler can have a carbon footprint equivalent to driving a gasoline-powered car up to 170 km. In Canada, short-acting beta-agonist (SABA) inhalers constitute 71% of total inhaler use, the majority of which are delivered via MDI devices. For these reasons, strategies that reduce the use of MDIs have the potential to reduce negative environmental consequences of respiratory care.