Climate change can have an effect on our health as well as on our planet.  

There are many ways that make climate change especially bad for lung health. These include poorer air quality, forest fires, increases in pollen levels and moulds as well as difficulties coping with direct effects of heat.

The NHS in England is responsible for an estimated 5% of the country’s carbon footprint. This is equivalent to all the planes taking off from Heathrow in an average year.

NHS's approach for tackling climate change

The NHS plans to play its part in tackling climate change and the ‘For a Greener NHS’ programme aims “to deliver the world’s first net zero health service and respond to climate change, improving health now and for future generations”:

  • The NHS Carbon Footprint: for the emissions we control directly, net zero by 2040

  • The NHS Carbon Footprint Plus: for the emissions we can influence, net zero by 2045.

Delivering a ‘Net Zero’ National Health Service identified a number of areas in which the NHS can focus its efforts:

  1. Estates and facilities
  2. Travel and transport
  3. Supply chain
  4. Medicines

Medicines account for 25% of emissions within the NHS. Within medicines, inhalers are the single biggest contributor to the carbon footprint.

Low carbon inhalers

Inhalers are used in a variety of respiratory (lung) conditions, such as asthma and chronic obstructive pulmonary disease (COPD).

Some inhalers use propellants to create a spray of medication droplets which the person inhales. These are called pressurised metred dose inhalers (pMDIs). The propellants in pMDIs are a powerful greenhouse gas. They are safe for the person using them but they have a much bigger impact on the environment than dry powder inhalers (DPIs) or low carbon inhalers delivering the same medicine. That’s because dry powder inhalers (DPIs) don’t use propellant gases, instead using a person’s breath to deliver the dose. DPIs therefore have a much lower environmental impact. Dry powder inhalers have an estimated carbon footprint equivalent of just 20g per dose compared with 500g in MDIs.  So switching to a DPI from an MDI can help to reduce not only the NHS carbon footprint, but also your own carbon footprint!  This can have a bigger impact than eating less meat or planting a tree. (see greeninhaler.org)

For most people, either type of inhaler is equally effective. In many cases a DPI inhaler can be easier for a patient as they have a counter (so you know when it is running out), it does not need a spacer device, and it can be easier to co-ordinate with your breathing so making sure that the drug gets to your lungs.  Most people, once shown the correct technique, can master a DPI.

Salford's switch to green inhaler

Salford CCG is introducing more environmentally friendly inhalers, prescribed for conditions like asthma and COPD. Your clinician may discuss switching your inhaler at your next respiratory review. 

Eco inhalers are 25 times better for the environment than gas propelled inhalers. 

If you have received your new eco inhaler, please return your old inhaler and other medicines to your pharmacy for proper disposal so that they don't go to landfill. 

Difference betweek Dry Powder Inhaler and Metered Dose Inahler

Type of inhaler

Dry Powder Inhaler / Green inhaler

Metered Dose Inhaler

What is the climate change impact?

Small – typically equivalent to 1kg of CO2 per inhaler

Very large – typically 20kg of CO2 per inhaler, but it can be more than twice this amount.

Do I need to breathe in and press button at the same time?

No, the dose can be prepared before breathing in through the inhaler

Usually yes, although some “breath-activated” devices don’t require you to press a button

What sort of breath in should I do?

Strong and deep breath.

Slow and steady deep breath

Can it be used with a spacer?

No, there is no need for a spacer.

Yes, nearly all can be used with a spacer, and should be, as this will improve the amount of medicine getting to your lungs

Does it have a dose counter?

All dry powder inhalers either come with a dose counter, or sometimes you put a capsule in each time you use it

Most reliever inhalers and steroid inhalers don’t have a counter, so you need to keep track of how many doses you’ve used

In other countries like Sweden 87% of inhalers are DPI whereas in UK it is only 30%.  This helps to show that moving to more use of DPI inhalers can be done safely.

What does this mean for me?

Your inhalers will not be changed without your knowledge and agreement; not all inhalers are suitable for every patient. The best inhaler for you is that one that gives you the best control of your lung condition.

Your GP practice will contact you and ask you to make an appointment for a review.  It’s a good idea to take all your current inhalers with you.  At the review, a healthcare professional will review your condition, ask about symptoms, check how you are getting on with the inhalers that you already have, and discuss whether a switch to a greener inhaler would be suitable.  You will be able to ask questions and may also be able to look at example inhalers.

Where someone can use a dry powder inhaler effectively to deliver the same medication, then that is likely to be the preferred option – giving benefit to the patient and the environment too.

If you do decide to switch, you will be given training on how to use it and reviewed after a short period of time to see how you are getting on.  This may be by the person who changed your inhalers, or the pharmacist who dispensed them.

If you need a reminder how to use your inhaler properly, Asthma UK have produced videos showing how to use the different types of inhaler.

If you do change, you probably won’t notice any difference in your symptoms.  Sometimes there is actually improvement if you are better able to use the new device.  However, if there is any worsening you you should contact your doctor or nurse to be reviewed, check how you are getting on, if you are using the inhaler properly or if you need to change back again. If you do need to carry on using an pMDI don’t worry, the most important thing is that people get good control of their lung condition and for this some people need MDI inhalers. 

Finally, don’t throw your used inhaler in the bin!  Make sure that you use up all the doses in it before starting a new one.  Once you are sure it is empty, please return it to the pharmacy for proper disposal.  This means that it won’t end up in landfill where the gases will continue to be released into the environment and will help with recycling.