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How Environmentally Friendly Is Your Inhaler?

Most of us with asthma have a pretty definite preference for the type of inhaler device we use. I often find it disappointing that new medicines are not formulated in my preferred inhaler type--the good old, classic, metered dose inhaler, also known as an MDI or pMDI (with the P being for pressurized).

I know my friends with asthma have similar preferences for their device of choice, too. So when a friend messaged me and recommended trying a specific new inhaler, out of curiosity, I checked if there were any triple-combos available in MDI in advance of my asthma clinic appointment.

Not finding any, I asked my asthma specialist about it. She noted there has been a move away from MDIs for environmental reasons, but that they are more recyclable than other newer inhalers.

The great propellant debate

Depending on when you were diagnosed with asthma, you may not remember the switch from CFC (chlorofluorocarbon) inhalers to HFA (hydrofluoroalkane) ones. This happened right before my diagnosis in April 2008, as this was a big topic I saw people talking about online! I cannot recall a lot of specifics, but the mist produced by HFA MDIs felt different than the CFC formulations folks were used to. I myself never used a CFC inhaler, and based on what I had read, I was happy I did not have to make such a switch!

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This switch happened because HFA propellants were deemed to be less hazardous to the ozone layer than CFC--where, of course, that second C stands for carbon, the main element leading to damage of the Earth's atmosphere, and contributing to climate change.

So, what gives then? Didn't we switch to something that solved the problem? Apparently not. While HFA inhalers are not "as bad" as CFC ones, they still have an impact on the environment.

However, we could estimate even if I used all 4 of my inhalers 2 puffs, twice a day (which I do not) is about 1500 grams of carbon dioxide emitted per day.1

But let's look at the big picture: The average 15 km car trip is 2610 grams of carbon emission, and the average Canadian drives 20,000 km/year, or 55 km/day. At about 175 g CO2 per kilometer, that's about 9625 g CO2/day... more than 6 times greater than even my (over)estimated inhaler use.1,2

I get it: every bit helps. I have an electric scooter, after all. It charges on low-carbon emission hydro-generated power, and if I had taken all my scooter trips since I got it just over a year ago by car that would have been 5 times the emissions.

I understand this is a both/and scenario, and I am happy to do my share. But if propellant-based inhalers are indeed being phased out due to environmental concerns...is this not a pretty small drop in the bucket compared to driving a vehicle, especially when I cannot drink orange juice (360 g/CO2 emitted per 250 ml) and do not eat meat (5000 g/CO2 emitted per burger)? 1

How recyclable is your inhaler?

Before I began returning all my empty inhalers to the pharmacy a couple times a year for ease, I would pop the canister out and recycle the plastic outer shell. Technically speaking, yes, canisters are recyclable, but given the pressurized, exploding nature of them, I did not put these into the recycling. I also think I would just toss Symbicort and Pulmicort Turbuhalers in the recycling back when I used those, as well--in retrospect, I don't know how much of those were recyclable.

Not knowing what happens to my inhalers after they are returned to the pharmacy, though (and I did try to do a deep-dive and find out once!), means even if I do the right thing and return the inhalers to the pharmacy, I still don't know where they go, or how much is actually recycled! So, while MDIs might (according to my doctor) be the most recyclable...where are they actually going and how are they actually being handled? I wish I had an answer to that.

Are there other ways to have environmentally friendly inhalers for asthma?

It would seem that when it comes to inhalers, there is more than one way to be environmentally friendly. Being able to understand the offset would be interesting--does recycling the plastic (and metal where possible) bits of the inhaler offset emissions caused by inhalers by not having to make entirely new materials? How many of the parts inside dry powder inhalers are actually recyclable...and how many are being recycled regardless?

I think these are all good considerations to keep in mind. However, is it fair to people with lung disease to be decreasing availability of medications in different forms, decreasing choices, for non-clinical reasons when other day-to-day activities that everyone may partake in are equally, if not more, hazardous to the environment?

Absolutely,educate patients to make the decision that aligns best with their values. Without question, manufacturers should make the medications we are used to taking more environmentally friendly, as well as ensure drugs are being manufactured in the most sustainable way possible - in places that use renewable electricity sources, for instance, and with the most environmentally-friendly shipping options from end-to-end.

Yes, metered dose inhaler devices have an impact on climate change: but so do many other things that are optional, and far less critical to our health in the short term. I will contribute happily in whatever other ways I can to offset use of the inhaler device I prefer...while remaining able to breathe and function.

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