‘Greener’ choices in inhalers are gaining support from pharmaceutical companies and device makers

Many companies, including dozens of pharmaceutical companies, set net-zero emissions targets following COP26. The health industry is a particularly important stakeholder because climate change, health and medicine are inextricably linked.

Rising global temperatures are associated with several negative health effects, including asthma, cardiovascular disease, infectious diseases and other heat-related illnesses. Yet healthcare is one of the most carbon-intensive service sectors in the US economy.

Given the main objective of the health sector – to save the lives of patients and improve health outcomes – companies must account for their contribution to climate change. Some pharmaceutical and medical device companies have taken up the challenge to innovate with more environmentally friendly alternatives to their product.

For example, some have developed pressurized metered dose inhalers (pMDIs) using propellants with low risk of global warming to treat asthma and COPD patients.

Low carbon impact inhalers

Metered-dose inhalers (MDIs), containing hydrofluoroalkane propellants (HFA; typically, HFA134a or HFA227ea), are widely prescribed in the United States for acute symptoms and long-term management of asthma and COPD.

The propellant is needed to atomize the drug formulation, allowing precise and repeatable dosing of active agents in each puff. HFA, a potent greenhouse gas, is to be phased out under the Kigali Amendment to the Montreal Protocol. This has spurred innovations to facilitate the transition from HFA metered-dose inhalers to low-carbon alternatives, such as dry powder inhalers (DPI, propellantless).

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We analyzed 2019 Medicare Part D drug expenditure data combined with published inhaler carbon footprint data to broadly demonstrate the potential impact of switching from HFA metered-dose inhalers to DPIs. We focused on two types of commonly prescribed inhalers: albuterol sulfate (short-acting beta-agonists, SABAs) and fluticasone propionate (inhaled corticosteroids, ICS).

This analysis illustrates the economic and environmental implications of switching from HFA MDIs to DPIs, as well as the potential value of investing in low-carbon alternatives to HFA MDIs.

We found that only about 4.8% of Medicare Part D beneficiaries who received Albuterol and 10.9% who received Fluticasone inhalers use the DPI version. This is somewhat comparable to the proportion of PGD use in the UK (6% SABA, 6% ICS), but far behind that of Sweden (90% SABA, 85% ICS).

Meanwhile, the average total annual drug expenditure per beneficiary using PGD tends to be lower than those using HFA MDI proportionately.

Economic and environmental impact of switching to low carbon impact inhalers

With respect to current use of HFA MDIs, for every 10% of Albuterol HFA MDIs replaced with Albuterol DPI, the total annual drug expenditures (the amounts paid by Medicare Part D and beneficiary) is estimated to be reduced by $16.6 million, while 122 kt of CO2e (9.6% of the carbon footprint of Albuterol inhalers) could be avoided each year.

Similarly, for every 10% of Fluticasone HFA MDIs replaced by its DPI counterpart, the total annual cost is expected to be reduced by $6.4 million and 8 kt CO2e (9.5% of the carbon footprint of fluticasone inhalers) would be saved each year.

Reducing the proportion of Albuterol HFA metered-dose inhaler use to 10%, as in Sweden, would result in carbon savings of 1,096 kt CO2e annually, thanks to the reduction of the carbon footprint during the use phase (71%) and the end-of-life phase (27%) of the device, while offering a reduction of $148 million the annual prescription cost.

Applying the proportion of Swedish ICS metered-dose inhaler use (15%) to the Fluticasone HFA metered-dose inhaler in the Medicare Part D population results in an estimated reduction of 69 kt CO2e annually (60% from in-use phase, 31% from end-of-life phase, 9% from manufacturing) and $53 million in annual prescription cost savings.

Implications of environmentally friendly medicine

Thus, if prescribers are able to switch from HFA metered-dose inhalers to DPI options within each therapeutic class, major economic savings and substantial carbon reductions could be achieved. DPIs may not be the best solution for all patients clinically, as DPIs require patients to have sufficient respiratory strength to inhale the drugs; but even a small transition could still yield significant results.

In addition to incentivizing the use of currently available DPIs, these results also point to the large potential market for more climate-friendly alternatives to traditional metered-dose inhalers, which will only expand given increased awareness and growing commitment to mitigating climate change.

Some companies have been at the forefront of developing alternatives, such as carbon footprint metered-dose inhalers comparable to typical DPIs. This surge of green innovations, in turn, sends stronger market signals to policymakers that accelerating their national agenda to slow climate change includes goals that are achievable at a reasonable cost, while providing investor confidence. to support greener initiatives.

Additionally, green medical innovations can provide patients with choices about the type of treatment that is best for them, clinically and socially; therefore, likely encourages more open conversations between prescribers and patients about the appropriateness of treatments while encouraging appropriate use and less waste.

This analysis shows just one example of how greener choices and innovation could help mitigate the destructive health effects of climate change and how the health industry could contribute to a more sustainable future.

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