One medical inhaler can have the impact of 30kg of carbon dioxide – Chemistry World

Report on the Environmental Impact of Medical Inhalers and Alignment with Sustainable Development Goals

Introduction: A Healthcare Challenge for Climate Action and Well-being

The healthcare sector’s contribution to global greenhouse gas emissions is under increasing scrutiny, with a significant and often overlooked source being Metered Dose Inhalers (MDIs). These devices, critical for managing conditions like asthma and COPD and thus central to SDG 3 (Good Health and Well-being), utilize propellants with high Global Warming Potential (GWP). The emissions from a single MDI can be equivalent to driving a petrol-powered car for 200 miles, directly conflicting with the objectives of SDG 13 (Climate Action). This report details the industry’s response, regulatory pressures, and available alternatives aimed at aligning respiratory care with global sustainability targets.

Regulatory Frameworks and Industry Innovation for Sustainable Production

Global Mandates Driving a Transition

International agreements and regional regulations are compelling the pharmaceutical industry to adopt more sustainable practices, reflecting a global commitment to SDG 12 (Responsible Consumption and Production) and SDG 17 (Partnerships for the Goals). Key drivers include:

• The Montreal Protocol (1987): Successfully initiated the phase-out of ozone-depleting chlorofluorocarbons (CFCs), setting a precedent for global cooperation on atmospheric protection.
• The Kigali Amendment (2016): Extended the Montreal Protocol to mandate the phase-down of hydrofluorocarbons (HFCs), which replaced CFCs but are potent greenhouse gases.
• EU F-Gas Regulations: Impose an accelerated phase-down of HFCs in Europe, creating significant market and financial pressure on manufacturers to innovate.

Pharmaceutical Sector Response: Developing Low-GWP Alternatives

In response to regulatory pressure and corporate sustainability commitments, leading pharmaceutical companies are developing next-generation inhalers with a significantly lower climate impact.

1. AstraZeneca: Has secured approval for a COPD inhaler using HFO-1234ze, a propellant with a GWP stated to be 99.9% lower than current HFCs. This innovation directly supports the transition to sustainable production patterns under SDG 12.
2. GSK: Is advancing a low-carbon version of its Ventolin inhaler, which currently accounts for nearly half of the company’s climate impact. The new formulation uses HFC-152a, reducing the GWP by approximately 90% and demonstrating a tangible commitment to SDG 13.

Evaluating Sustainable Alternatives and Overcoming Implementation Barriers

The Role of Dry Powder Inhalers (DPIs)

An immediate opportunity to reduce emissions lies with Dry Powder Inhalers (DPIs), which are propellant-free and can lower the carbon footprint by up to 98% compared to conventional MDIs. However, their widespread adoption faces several challenges that must be addressed to fully leverage their potential for advancing SDG 12 and SDG 13.

• Environmental Benefit: DPIs offer a readily available, low-carbon alternative for many patients.
• Economic Barriers: In markets like the United States, DPIs can be significantly more expensive due to pricing structures and insurance preferences, hindering responsible consumption choices.
• Prescribing Practices: Cultural and habitual prescribing patterns, such as the high prevalence of MDI use in the UK compared to Sweden, act as a barrier to change.
• Clinical Suitability: A small subset of patients may lack the necessary lung function to effectively use DPIs, underscoring the need for a range of options to ensure patient health (SDG 3).

Future Outlook: Balancing Clinical Needs with Climate Imperatives

Scientific Considerations and Strategic Pathways

The transition to greener inhalers involves ongoing scientific evaluation and strategic decision-making. Recent laboratory studies suggest that HFO propellants may have an indirect warming effect not captured by standard GWP calculations, highlighting the complexity of achieving true sustainability. Despite this, the move away from high-GWP HFCs represents a critical step forward.

Recommendations for a Sustainable Transition

Achieving a sustainable future for respiratory care requires a multi-faceted approach grounded in the principles of the Sustainable Development Goals.

1. Accelerate HFC Phase-Down: Prioritizing the rapid reduction of short-lived but potent HFCs can deliver significant near-term climate benefits, directly contributing to the urgency of SDG 13 (Climate Action).
2. Integrate Sustainability into Healthcare Systems: Health systems and policymakers must reform procurement and reimbursement policies to favor low-emission inhalers, embedding SDG 12 (Responsible Consumption and Production) into operational practice.
3. Uphold Patient-Centric Care: The transition must balance environmental responsibility with clinical efficacy and patient choice, ensuring that actions taken to protect the climate do not compromise SDG 3 (Good Health and Well-being).
4. Strengthen Multi-Stakeholder Partnerships: Continued collaboration between governments, industry, healthcare providers, researchers, and patient advocates is essential to navigate the complexities of this transition, embodying the spirit of SDG 17 (Partnerships for the Goals).

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article highlights issues that are directly and indirectly connected to several Sustainable Development Goals. The primary focus is on environmental sustainability within the healthcare sector, but this intersects with health outcomes, industrial innovation, and global cooperation.

• SDG 3: Good Health and Well-being

  The article is centered around inhalers, which are essential medical devices for managing chronic respiratory diseases like asthma and COPD. The discussion on the availability, cost, clinical suitability, and patient choice between different types of inhalers (MDIs vs. DPIs) directly relates to ensuring access to effective and safe medicines.

• SDG 12: Responsible Consumption and Production

  This goal is addressed through the article’s focus on the environmental impact of a consumer product (inhalers). It discusses the lifecycle of these products, from the chemicals used as propellants to the push for more sustainable alternatives. The efforts by pharmaceutical companies to develop low-GWP inhalers and the advocacy for prescribing less harmful options like DPIs are core to achieving sustainable production and consumption patterns.

• SDG 13: Climate Action

  This is the most prominent SDG in the article. The entire narrative is driven by the climate impact of Metered Dose Inhalers (MDIs) due to their use of powerful greenhouse gases (HFCs) as propellants. The article quantifies this impact, discusses international regulations like the Kigali Amendment aimed at phasing down these gases, and explores technological solutions to mitigate these emissions, which are all urgent actions to combat climate change.

• SDG 17: Partnerships for the Goals

  The article illustrates the importance of collaboration among various stakeholders. It mentions pharmaceutical companies (AstraZeneca, GSK), researchers (Jyothi Tirumalasetty, Ashley Woodcock), regulatory bodies (UK’s drug regulator, EMA, FDA), and international agreements (Montreal Protocol, Kigali Amendment). This multi-stakeholder approach, involving public, private, and civil society actors, is essential for achieving the transition to environmentally friendly healthcare products.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, several specific targets under the identified SDGs can be pinpointed:

1. SDG 3: Good Health and Well-being

   • Target 3.4: Reduce by one-third premature mortality from non-communicable diseases. The article discusses treatments for asthma and COPD, which are chronic non-communicable diseases. The debate over the clinical equivalence and patient suitability of different inhalers is relevant to ensuring effective treatment.
   • Target 3.8: Achieve universal health coverage, including access to affordable essential medicines. The article highlights the cost of different inhalers as a significant barrier to adoption. For example, it notes that lower-emission DPIs can be more expensive and that prescribing practices are often driven by cost, as seen with Medicare/Medicaid preferences in the US.

2. SDG 12: Responsible Consumption and Production

   • Target 12.4: Achieve the environmentally sound management of chemicals and all wastes throughout their life cycle… and significantly reduce their release to air. This target is directly addressed by the focus on phasing out high-GWP HFC propellants in inhalers and replacing them with alternatives like HFO-1234ze and HFC-152a to reduce the release of potent greenhouse gases into the atmosphere.

3. SDG 13: Climate Action

   • Target 13.2: Integrate climate change measures into national policies, strategies and planning. The article explicitly cites the Kigali Amendment to the Montreal Protocol and the EU F-Gas Regulations as key policy drivers compelling pharmaceutical companies to develop low-GWP inhalers.
   • Target 13.3: Improve education, awareness-raising and human and institutional capacity on climate change mitigation. The story of Dr. Jyothi Tirumalasetty discovering the overlooked emissions from inhalers at Stanford Medicine exemplifies the need for increased awareness within the healthcare system. Her efforts to educate colleagues and change hospital ordering systems directly contribute to this target.

4. SDG 17: Partnerships for the Goals

   • Target 17.17: Encourage and promote effective public, public-private and civil society partnerships. The article describes a complex partnership involving private pharmaceutical companies (GSK, AstraZeneca) investing in new technology, public health systems (UK NHS) measuring their carbon footprint, and researchers/advocates pushing for change.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions several quantitative and qualitative indicators that can be used to measure progress:

1. Indicators for SDG 3 & 12

   • Cost of Medicines: The article provides specific cost comparisons, such as “Proventil costs 50% more than Ventolin” and “ProAir RespiClick works out as 25% more expensive than the GSK MDI product.” Tracking the price of different inhaler types serves as an indicator for affordability (Target 3.8).
   • Prescription Rates: The statistic that “UK doctors prescribe MDIs to 70% of patients, compared to 13% of patients in Sweden” is a clear indicator of consumption patterns and prescribing culture, relevant to both health and responsible consumption goals.

2. Indicators for SDG 13 & 12

   • Global Warming Potential (GWP): The article uses GWP as a primary metric to compare propellants. It states the GWP of HFC-134a is 1530, while new propellants have GWPs that are “one-tenth” or “one-thousandth” of existing ones. This is a direct indicator for Target 12.4.
   • Carbon Footprint (CO2 equivalent): The emissions from inhalers are quantified in CO2 equivalent (CO2e). Examples include one MDI being equivalent to “driving 200 miles,” and specific products having footprints like 29kg of CO2e (Ventolin) versus 0.8kg of CO2e (ProAir RespiClick). This measures progress in reducing emissions.
   • Percentage of Sectoral Emissions: The statement that “MDIs of various brands are responsible for around 3% of the UK National Health Service (NHS)’s climate impact” is an indicator of the healthcare sector’s contribution to national emissions.
   • Emission Reduction Percentages: The article states that switching to HFC-152a can reduce climate impact by 93%, while DPIs offer up to a 98% reduction. These percentages are clear indicators of the effectiveness of mitigation strategies.

4. Summary Table of SDGs, Targets, and Indicators

Source: chemistryworld.com