Skip to main content

Greening respiratory healthcare without compromising patient safety


Reducing the environmental impact of single use inhalers for the treatment of asthma and other respiratory diseases has become an important touch point as the NHS seeks to achieve its promised ‘carbon neutral’ status. However, it’s important to place the impact of inhalers on the environment in context.

The NHS Sustainability Development Unit (SDU) estimates that about 4% of NHS greenhouse gas emissions are accounted for by inhaler usage and the NHS as a whole accounts for about 3% of the overall greenhouse gas emissions in the UK. That said, propellant gases in pressurized metered dose inhalers (pMDIs) undoubtedly incur an environmental cost. Until propellants with a low global warming potential (GWP) become available this cost must be balanced against patient safety first and foremost and the cost of healthcare utilization due to poorly controlled respiratory symptoms second.

The goal of treatment for patients with chronic respiratory disease is to achieve the best possible symptom control. How this is achieved differs between individual patients. Propellant-free inhalers, such as dry powder inhalers (DPIs) and soft mist inhalers (SMIs) are available for the delivery of respiratory medications and are suitable for routine treatment for most adult patients. However, not all patients have the inspiratory capacity to achieve the technique required to use these types of inhaler, especially during emergency situations where the supplementary force supplied by the propellant is critical in delivering the medication into the lungs where it is needed. Moreover, propellant-free devices incur additional environmental costs in terms of their manufacture and safe disposal as most are still designed as single use devices.

Blanket switching of all patients currently receiving their medication via a pMDI to an alternative inhaler type has the potential to place patients at increased risk for serious, potentially life-threatening, exacerbations if they are not able or willing to use the device correctly and is not an approach supported by PCRS. Instead, inhaler choice should be made on an individual basis with environmental impact part of the decision process. Changing from one inhaler device to an alternative with a lower GWP delivering the same or equivalent medication should be considered where the change is clinically appropriate, safe and acceptable to the patient.

Further information

Inhaler switching position statement

Greener Respiratory Pathway

Greener Respiratory Healthcare Quality Improvement Toolkit