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Breathing deep: The environmental impact of inhalers

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Canada is caught in a vicious cycle when it comes to maintaining respiratory health in the face of climate change. 

The cycle commences with an increase in respiratory ailment diagnoses, with 3.8 million Canadians, constituting ten per cent of the population aged one or above, grappling with asthma, alongside an additional two million individuals afflicted by chronic obstructive pulmonary disease (COPD). The diagnoses of these persistent conditions are anticipated to rise even more as Canada’s population ages and air quality worsens. 

Because of these conditions, inhalers are often prescribed to help with symptoms. 

However, the irony is found in the fact that the most used inhalers, such as pressurized metered dose inhalers (pMDI) or breath-actuated inhalers (BAI), contain hydrofluorocarbon (HFC) propellants which are potent greenhouse gases. The very same greenhouse gases contribute to climate change with something as simple as their usage, on top of the plentiful number of environmental stressors that the production and disposal of these inhalers produce.

Another way pharmacy professionals can aim to cut down on inhalers’ impacts on our climate is through proper diagnosis and deprescribing. 

These factors exacerbate environmental degradation, furthering the effects of climate change. This, in turn, worsens environmental conditions that aggravate respiratory conditions, leading to uncontrolled symptoms, increased inhaler usage, and a heightened risk of asthma and COPD exacerbations. Thus, the cycle continues, perpetuating the rise in respiratory ailments among individuals. 

But, as pharmacy professionals, we can and must help to put a stop to this cycle. 

Pharmacy professionals possess a unique opportunity to inform prescribers, colleagues, and patients about environmentally sustainable inhaler practices.

One potential approach could involve discontinuing the prescription of HFC-heavy pMDIs and BAIs, opting instead for dry powdered inhalers (DPI) and soft mist inhalers (SMI), which lack these propellants and therefore have a reduced carbon footprint.

Another is to properly educate prescribers, colleagues, and patients on environmentally sustainable practices including the proper use and disposal of inhalers. Educating patients on correct inhaler use improves medication delivery and reduces environmental impact. Spacer devices and dose counting methods enhance efficiency. 

Additionally, education on proper disposal of all inhalers by a pharmacy team remains equally important. For instance, the aforementioned pMDIs’ high carbon footprint does not end in their use. Shockingly, their disposal phase accounts for approximately 85 per cent of the total pollution they cause. By championing proper disposal, including incineration to destroy HFCs, we can mitigate these effects. There are programs in several provinces that even support medication returns through community pharmacies, promoting environmentally responsible disposal. 

Finally, another way pharmacy professionals can aim to cut down on inhalers’ impacts on our climate is through proper diagnosis and deprescribing. Eliminating unnecessary inhalers helps avoid overuse and waste, decreasing the healthcare sector’s carbon footprint. In fact, The Canadian Thoracic Society advocates for this, stating that if inhaler therapies exhibit no clinical improvement or lack confirmatory test results in patients, to stop using them. This strategy aims to mitigate patient risks and reduce healthcare resource strain from misdiagnosis and overprescribing. 

Pharmacy professionals, through education, interventions, and advocacy, can lead the charge in promoting eco-friendly inhaler practices. By incorporating these strategies into daily practice, pharmacists can contribute to a healthier planet and better patient outcomes.

To dive deeper into a more clinical perspective on this topic, I invite readers to check out my Clinical Pearl and Resource Spotlight on CSHP.ca! 

Layne Liberty is a former CSHP student and Doctor of Pharmacy graduate from the University of British Columbia.

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