Image of NHS leaflets about inhaler choices
Ventolin salbutamol MDI inhaler (higher propellant volume), 1 device = 282km of driving. Salamol salbutamol MDI inhaler (lower propellant volume) 1 device = 100km of driving.

Hayley Carmichael
5 minute read

Inhaler use contributes significantly to the carbon footprint of healthcare and addressing it has been identified locally and nationally as a priority action. NHS Sussex has created a range of information for patients and GP's to help inform inhaler use across our region.

Why are inhalers an issue?

Climate change poses a major threat to our health as well as our planet. The environment is changing, and this has direct and immediate consequences for our patients, the public and the NHS.

Climate change is negatively affecting people with respiratory problems as it causes increased water and air pollution and hotter dryer days, all which can trigger respiratory symptoms.

NHS England has set a target for all NHS organisations to reach Net Zero Carbon by 2040. Within the public sector the NHS accounts for 40% of the national carbon footprint.

Currently 4% of the NHS carbon footprint comes from pressurised Metered Dose Inhalers (pMDI). Within Primary Care that increases to an astounding 25% of the carbon footprint.

Image of Britain showing London to Sheffield.
The most common pMDI in the UK is a Ventolin Evohaler. The full use of just one inhaler has a carbon footprint equivalent to driving from London to Sheffield.

In Sussex alone we prescribe about 1.3 million inhalers a year and 73% are pMDIs. This creates over 20,000 tonnes of carbon emissions every year which is the equivalent of the energy used in one year for 2,500 homes. It is the propellant in pMDIs that contains a harmful greenhouse gas, which is significantly more potent than carbon in the damage it does to our environment.

Breath Actuated Inhalers (BAI) also contain this damaging propellant (e.g. autohaler and easi-breathe devices). While pharmaceutical companies are looking at changing the propellant used in their inhaler(s) to reduce the carbon impact, it will be 2027 before new pMDI products are likely to reach market.

What is the solution?

Good inhaler technique and managing asthma well is the ideal way to help tackle the carbon footprint of inhalers.

Used regularly, a preventer inhaler will help people stay well with fewer symptoms, meaning they  don't need the blue (reliever) inhaler so often.

One option is switch from a metered dose inhaler to a dry powder inhaler.

Dry Powder Inhalers (DPI) do not have this propellant and therefore are a more carbon friendly alternative to pMDIs/BAIs. If we can get more patients using DPIs, or Soft Mist Inhalers (SMI) (e.g respimat devices), then we can significantly reduce the carbon footprint of primary care.

Another option is to swap Ventolin for Salamol; while still a metered dose inhaler, it has a lower carbon footprint.

Salamol MDI has less than half the carbon footprint of Ventolin evohaler as it contains far less propellant gas in the device. This means that less harmful gas is released into the atmosphere when it is used.

By moving half of all the Ventolin Evohaler prescriptions across Sussex to Salamol MDI we will save 2000 tonnes of carbon emissions every year. It would take 33,000 trees 10 years to capture this much carbon.

Look out for our information

To help patients across Sussex choose the right inhaler for them, and the environment, NHS Sussex, in partnership with Care Without Carbon, has created a set of leaflets and posters to give them all the information they need.

These will enable patients to open up conversations with their GP or asthma nurse and explore how to make a change that works best for them.

A short booklet for GP's has also been produced, so GP's can feel confident they have all the facts they need when discussing any changes to inhalers with their patients.

Image of NHS leaflet about inhaler choices.

A series of short films is also being created to use across social media, with real people who have already made a change talking about what it was like for them.

If we can achieve a significant reduction in the carbon emissions from inhaler use it will help us get closer to our goal of Net Zero Carbon by 2040.