Saving The Planet One Puff at a Time

One area of clinical practice where we can, collectively, make a positive impact on climate change is in the management of our patients’ asthma and COPD. Inhalers are a mainstay of therapy for these conditions, though they are not created equal in terms of their carbon footprint; the propellants in pressurized metered dose inhalers (pMDIs) are potent greenhouse gases.

An article in the May, 2023 BCMJ by Dr. Kevin Liang and others reported on their study of community prescriptions for inhalers in the Fraser Valley over a 5-year span ending in 2021. They found the average yearly CO2 equivalence from pMDIs was nearly 8,500 tonnes. They went on to model how much carbon would be reduced if other inhalers – dry powder or soft mist – were prescribed instead. The amounts are impressive and sobering. Each pMDI represents the CO2 roughly equal to driving 170 km in a gas combustion car.

The future might hold new MDI propellants with much lower carbon footprint, currently under development. For now, we can offer choices in the available inhalers we prescribe. As always, we family docs will have to navigate patient tolerability and acceptance, and the cost of medications if/when they aren’t covered by Pharmacare benefits.

Here are some resources that might help you in your decision-making and make switching your patients’ inhalers to greener alternatives a bit easier:

• A toolkit for primary care providers seeking better, greener asthma management
• The BC Inhaler guide provides information on various asthma and COPD treatments and their ‘green’ rating
• BC Guidelines reference with environmental impact, doses, cost and coverage of asthma medication
• BC Provincial Academic Detailing Service’s table of COPD medications including dosage, cost and coverage. Included is a link to Pharmacare criteria for getting coverage.

Finally, for clinics interested in taking a deeper dive with a presentation and discussion, Drs. Kevin Liang and Kelly Lau are prepared to come out and support you to ‘green’ your respiratory care. This can be arranged through the VPSA (Vancouver Physician Staff Association). Contact Ms. Annapurna Chavali, her email is achavali@vpsa.ca.