Switching from metered-dose inhalers to dry powder inhalers
Photo: Orawan Pattarawimonchai/Shutterstock
Needle Nudger (>0.5 tCO₂e or <1 tCO₂e per primary practice)Inhalers are used to treat many respiratory conditions. Specifically, metered-dose inhalers (pMDIs) use hydrofluorocarbons as propellants which have global warming potentials thousands of times higher than carbon dioxide. Each pMDI canister has a footprint of 500g–1.5kg CO₂e.
Dry-powder inhalers (DPIs) and soft-mist inhalers have much lower carbon footprints and are clinically effective alternatives for many patients. Ensuring proper use, shared decision-making, and safe disposal further reduces emissions. An estimated 10% MDI users can transition to DPIs.
This solution is featured by Choosing Wisely Canada
“Don’t prescribe greenhouse gas-intensive metered-dose inhalers (MDIs) for asthma and/or COPD where an alternative inhaler with a lower carbon footprint (e.g., dry powder inhaler (DPI), soft-mist inhaler, or MDI with a low greenhouse gas potential propellant) containing medications with comparable efficacy is available, and where the patient has demonstrated adequate technique and patient preference has been considered. ”
Metered-dose inhalers (MDIs) contain HFC propellants, which contribute to global warming. When prescribing inhalers, providers should consider whether an objective diagnosis of asthma and/or COPD exists or needs to be confirmed, in keeping with existing CWC CTS recommendations (#1 and #5). Also, optimal choice of controller inhaler agents and non-pharmacologic strategies (e.g., education, trigger avoidance, action plans) should always be included in airway disease management, as they not only improve patient outcomes, but can also reduce rescue inhaler use. Low carbon footprint inhalers may not be appropriate for some patients (i.e. preschool children, individuals with certain cognitive limitations, end-stage lung disease, muscle weakness or other physical limitations, and during respiratory emergencies). Other patients simply prefer MDIs. Ultimately, whether starting or substituting an inhaler, providers must consider medication efficacy, patient preference, adherence, technique, cost, and side-effect profile. A shared decision-making approach should be used, and the environmental benefits of alternatives to greenhouse gas-intensive MDIs should also inform this decision.
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This solution is featured by the Canadian Coalition for Green Health Care
Learn more about this solution in the Coalition's Green Health Care Guidebook.