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\begin{document}

\title{The environmental impact of inhalers for asthma; a green challenge and a
golden opportunity}



\author[1]{Alex Wilkinson}%
\author[2]{Ashley Woodcock}%
\affil[1]{East and North Hertfordshire NHS Trust}%
\affil[2]{Manchester University NHS Foundation Trust}%


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  \date{May 15, 2024}


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\begin{abstract}
The propellants used in metered-dose inhalers (MDIs) are powerful
greenhouse gases, which account for approximately 13\% of the NHS's
carbon footprint related to the delivery of care. Most MDI use is in
salbutamol relievers in patients with poorly controlled disease. The UK
lags behind in this regard with greater reliance on salbutamol MDI and
correspondingly greater greenhouse gas emissions; roughly treble our
European neighbours'. There has been a broad switch towards MDIs in the
UK over the last 20 years to reduce financial costs such that two-thirds
of asthma patients in the UK are on treatment dominated by salbutamol
MDI. Strategies that replace overuse of reliever MDIs with regimes
emphasising inhaled corticosteroids have the potential to improve asthma
control alongside significant reductions in greenhouse gas emissions.
Real-world evidence shows that once-daily long-acting combination
dry-powder inhalers can improve compliance, asthma control and reduce
the carbon footprint of care. Similarly, maintenance and reliever
therapy (MART) which uses combination reliever and inhaled steroids in
one device (usually a dry-powder inhaler) can simplify therapy, improve
asthma control and reduce greenhouse gas emissions. Both treatment
strategies are popular with patients, most of whom are willing to change
treatment to reduce their carbon footprint. By focussing on patients who
are currently using high amounts of salbutamol MDI, and prioritising
inhaled steroids via dry-powder inhalers, there are golden opportunities
to make asthma care more effective, safer and greener.%
\end{abstract}%



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