The carbon footprint of asthma inhalers

When floodwaters surged across the country (including West Auckland, where I live) during Auckland Anniversary weekend and Cyclone Gabrielle, the devastation prompted many to reflect on the climate crisis more broadly. For me, it sparked a deep dive into an often-overlooked contributor to global emissions: healthcare.

As a pharmacist and life-long asthmatic, I was stunned to discover just how significant the environmental footprint of asthma inhalers can be. Globally, the healthcare sector contributes an estimated 4-5 percent of carbon emissions, and about a quarter of that is tied to pharmaceuticals. Inhalers have a surprisingly high carbon footprint.

One study I came across estimated that switching from gas-propelled inhalers to dry powder alternatives could reduce an individual’s carbon footprint by as much as switching to a plant-based diet. That comparison really hit home.

Like many, I’d assumed the primary environmental concern with inhalers was the plastic casing, but the real impact lies in the hydrofluorocarbon (HFC) propellants inside some inhalers – potent greenhouse gases that can stay in the atmosphere for many years.

The pharmaceutical industry is developing new propellants with lower global warming potential, but as we saw with the change from chlorofluorocarbons in the 1990s, the roll out of these may take up to a decade. Dry powder inhalers (such as turbuhalers) contain no propellants and so they have a much lower carbon footprint.

Like many, I’d assumed the primary environmental concern with inhalers was the plastic casing, but the real impact lies in the hydrofluorocarbon (HFC) propellants inside some inhalers – potent greenhouse gases that can stay in the atmosphere for many years.

The pharmaceutical industry is developing new propellants with lower global warming potential, but as we saw with the change from chlorofluorocarbons in the 1990s, the roll out of these may take up to a decade. Dry powder inhalers (such as turbuhalers) contain no propellants and so they have a much lower carbon footprint.

Better health, lower emissions

This realisation came with a sense of guilt. Like many of us, I try my best to live sustainably – minimising waste, eating less meat, using cold washes, and switching to energy-efficient lighting. But I had never considered the environmental cost of a medication that is a lifeline for me, and nearly one in eight other New Zealanders who live with asthma.

The good news is that the better control you have over your asthma, the lower the carbon footprint of your treatment. A large proportion of the emissions associated with poorly controlled asthma come from excess use of reliever (or rescue) inhalers or the extra carbon burden of visits to the doctor or hospital or both. Anything you can do to take control of your asthma will help to reduce your carbon footprint and improve your health.

Simple steps can make a real difference, such as making sure you have a preventer inhaler, seeking healthcare advice when symptoms worsen, and getting your local pharmacist to check you are using your inhaler correctly; studies suggest about 80 percent of people don’t, which reduces how much medication reaches the lungs. Old inhalers should also be taken to your pharmacy for disposal so that residual HFCs do not seep out into the atmosphere.

What’s more, climate change and asthma are interlinked. As my colleague Amy Chan has pointed out on these pages, rising temperatures, air pollution, and changing pollen patterns are making asthma and allergies more common and severe. From a big-picture perspective, reducing our environmental footprint doesn’t just help the planet, it also helps protect people from worsening lung conditions in the long term.

Getting the right balance

Of course, the issue is complex. Inhalers save lives, and in emergency situations, reliability and familiarity are non-negotiable. Not everyone can use dry powder inhalers effectively – children, for instance, can struggle to get their technique right, and some patients may simply prefer to stick with what works for them if their asthma is well-controlled.

Getting this balance right is at the heart of a new research project I’m leading (funded by the Vernon Tews Charitable Trust). Our aim is to investigate how asthma treatments in New Zealand contribute to global warming, and how we can empower people with asthma to make informed choices about their treatments alongside their healthcare provider without any climate guilt.

Listening to young voices

Stage one of our study involves estimating the carbon footprint of different treatments available in New Zealand and analysing national dispensing and hospitalisation data to explore the environmental impact of well versus poorly controlled asthma.

Stage two will explore how to communicate this information in the right way. We’re especially interested in hearing from young people, who are more likely to experience climate change related anxiety. This generation will live longest with the consequences of climate change and stand to benefit the most from long-term health and environmental improvements.

We don’t – and won’t – pressure anyone. This is about enabling people to align their healthcare choices with their environmental values, wherever possible. Because sometimes, being green isn’t about sweeping changes, but small, informed choices that add up over time – especially when those choices can help us breathe easier in every sense of the word.