Despite themselves, asthmatics and lung patients contribute more than the average citizen to global warming. Substances in their “pumps” are involved. Climate-conscious doctors are now calling on Ottawa for regulatory change to replace harmful gases and eliminate these unnecessary emissions.
Metered-dose inhalers, small devices that deliver puffs of medicine down a patient’s throat, contain powerful greenhouse gases (GHGs). These only serve to propel the active agent. Depending on the molecule chosen, one gram of propellant gas warms the atmosphere 1400 to 3200 times more than one gram of CO2.
These gases – hydrofluorocarbons (HFCs), such as are found in refrigerating devices – are inhaled by the patients, retained for a few seconds in their lungs, then exhaled. They are therefore found in the atmosphere, where they contribute to the greenhouse effect. A typical metered dose inhaler contains 10 to 40 kg of CO equivalent2.
This may not seem like much, but on the scale of a country, the sum is considerable. No compilation is available in Canada. In the UK, metered dose inhalers take up an entire line of the national GHG balance sheet. They generate more than 900,000 tonnes of CO equivalent2 per year — as many as 300,000 gas-powered vehicles on the road, or one large cement plant.
“The health system contributes to worsening the climate crisis when it is, paradoxically, the number 1 threat to health in the 21st century.e century”, denounces anesthesiologist Stephan Williams, medical co-manager for carbon neutrality and sustainable development at the Center hospitalier de l’Université de Montréal (CHUM). “But metered-dose inhalers are one of the lowest fruits on the tree of things you can change easily,” he says.
Alternative options
Alternative options exist. Dry powder inhalers or aqueous mist inhalers, for example, do not use harmful propellants. The majority of patients could migrate there without any problem, according to specialists. Only people who are very ill, who find it very difficult to breathe in, and young children would need a metered dose inhaler with propellant gas.
The example of Sweden proves that less use of metered-dose inhalers is possible, without reducing the quality of care. In this country, these devices account for only 12% of inhaler prescriptions. In Canada and the United States, nearly 75% of inhalers currently prescribed are metered-dose inhalers. The situation is similar in the UK.
In addition to changing their prescribing habits, Canadian doctors want to attack the problem on another front. They asked the federal government this week to “plan”, with inhaler manufacturers, for the withdrawal of propellants with very high global warming potential over the next five years. They encourage Ottawa to organize the shift to other less harmful propellants, which should enter the market by 2025.
“Canada has set itself the goal of carbon neutrality and low-GHG health care. Here is a great opportunity to take action! write many medical associations, including the Canadian Association of Physicians for the Environment (ACME), the Canadian Medical Association and the College of Physicians of Quebec, in a letter sent Thursday to Steven Guilbeault, the Minister of Environment and Climate Change Canada, including The duty got a copy.
In 2009, Environment Canada piloted, in collaboration with Health Canada, the removal of chlorofluorocarbons (CFCs) from metered-dose inhalers, as these propellants destroy the ozone layer. Pharmaceutical companies had replaced them with HFCs. Since 2019, the Kigali Amendment to the Montreal Protocol requires the phase-out of HFCs due to their contribution to the greenhouse effect, but an exception applies to medical inhalers.
Decarbonize healthcare
According to the Dr Williams, a member of the Quebec branch of ACME, eliminating these unnecessary emissions is a no brainer. “It is not up to the government to invent the solution, but it is up to it to provide a regulatory framework for the industry. If we don’t give direction, there won’t be any results,” said the man behind the letter to the minister.
Already, pharmaceutical companies are developing metered-dose inhalers that work with HFC152a, a much less potent GHG. The companies Chiesi and AstraZeneca want to introduce these devices on the markets by 2025. Their motivation is climatic, but also economic. The cost of producing HFCs with high warming potential is expected to rise as almost all industries phase out them.
Dominique Massie, Executive Director of the Quebec Lung Association, also hopes that asthmatics and lung patients will have access to more environmentally friendly products. “We want to inform patients so that they ask their doctor for a pump that does not aggravate climate change,” she explains.
In the UK, a strong wind is blowing in favor of decarbonising healthcare. Last summer, Scotland set a target of reducing its emissions from inhalers by 70% by 2028. In the year 2020-2021, 4.5 million inhalers were sold in Scotland, for a total of 79,000 tonnes of CO equivalent2.
The CHUM, where the Dr Williams, recently set itself the goal of achieving carbon neutrality by 2040, without compromising the quality of care. “The problem is not that we ignore the solutions to decarbonize our health care, it’s that we are not structured to do so,” he laments. With his appeal to Minister Guilbeault, the doctor hopes to see things move quickly.