A new study just published in JAMA — the most high-profile medical journal — has uncovered some shocking and completely expected findings. These devices, essential for health management in asthma and Chronic Obstructive Pulmonary Disease (COPD), cause major environmental harm. The study, led by Dr. William Feldman, a pulmonologist at the David Geffen School of Medicine at UCLA, highlights that inhalers generate over 2 million metric tons of carbon emissions annually, equivalent to the emissions produced by approximately 530,000 gas-powered cars on the road each year.
The report focused specifically on emissions from metered dose inhalers (MDIs) approved for use in asthma and chronic obstructive pulmonary disease (COPD) from 2014‐2024. The study leveraged a unique NDUH database of all inhaler prescriptions filled in the U.S. by National Drug Code (NDC). It found that metered-dose inhalers present a harmful burden on the environment. Over the last 10 years, these inhalers together were responsible for a shocking 98% of the emissions.
Environmental Costs of Inhalers
Inhalers have historically been a first-line therapy for respiratory diseases. The environmental footprint of inhalers has recently come under fire due to the use of hydrofluoroalkane (HFA) propellants. These propellants are known to be very powerful greenhouse gases and were once commonly used in aerosol spray canisters. The increasing use of HFA propellants in metered-dose inhalers has led to worries over their role in global warming.
Dr. Feldman underscored why it’s important to raise awareness about this new environmental threat. He stated, “A key first step to driving change is understanding the true scale of the problem.” By bearing in mind the large emissions due to inhalers, stakeholders can take the first steps to reduce their environmental harm.
These findings show a critical need for innovation in inhaler technology. As Dr. Feldman pointed out, “On the upside, there is a tremendous opportunity to make changes that protect both patients and the planet by utilizing lower-emission alternatives.”
Implications for Patients and Healthcare
The consequences of these emissions are more than just environmental. They have direct human health impacts on patients with chronic respiratory diseases. According to Dr. Feldman, “Inhalers add to the growing carbon footprint of the US health care system, putting many patients with chronic respiratory disease at risk.” This two-pronged danger requires urgent response from both healthcare providers and policymakers.
Recognizing where these emissions are coming from is the first step toward creating targeted strategies to reduce them. Dr. Feldman noted, “From there, we can identify what’s fueling these emissions and develop targeted strategies to reduce them, benefiting both patients and the environment.”
It’s time for the healthcare industry to adopt sustainability as the norm. Simultaneously, it has to make sure that patients—all patients—get the right treatments for the right conditions. So, stakeholders can work together to research and develop new inhaler designs and formulations to test. Combined, they can help move the carbon footprint of respiratory care toward net-zero.
Future Directions and Recommendations
As the healthcare community comes to terms with the effects of climate change, reducing the environmental impact of inhalers must be at the forefront of the discussion. The results of this study highlight the value of examining established medical practices through an environmental framework.
As we move forward, research efforts should be aimed at developing and encouraging the uptake of lower-emission alternatives to HFA propellants in inhalers. Increased patient education on eco-conscious practices could help reinforce these efforts even more.