Clearing the air: Assessing inhaler usage and associated greenhouse gas emissions in a health system

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PURPOSE: The transition from chlorofluorocarbons (CFCs) to hydrofluoroalkanes (HFAs) has significantly reduced the greenhouse gas (GHG) emissions associated with metered-dose inhalers (MDIs). However, HFAs still have a high global warming potential (GWP) compared to other alternatives such as dry powder inhalers (DPIs) and soft mist inhalers (SMIs). This transition has significantly impacted GHG emissions, underscoring a need to evaluate the environmental impact of medication delivery via MDIs. OBJECTIVES: This study quantifies the GHG emissions, expressed as carbon dioxide equivalents (CO2e), from the use of HFAs in MDIs within our health system. The healthcare system includes 13 hospitals with over 2,000 staffed beds and approximately 100,000 annual patient admissions. It also examines the broader environmental impacts of the packaging materials associated with these inhalers. METHODS: A retrospective analysis of the use of albuterol and inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) MDIs over a 1-year period, assessing their CO2e emissions and the environmental impact of their packaging. The total weight of propellant was determined by calculating the difference in canister weight before use and after all contents were expelled. RESULTS: A total of 17,589 albuterol and 20,563 ICS/LABA MDIs were dispensed during the study. The total propellant weight led to CO2e emissions of 212 metric tons (MT) for albuterol MDIs and 506 MT for ICS/LABA MDIs. Including resource use and emissions from inhaler components led to an environmental impact that totaled 213 MT of CO2e for albuterol MDIs and 512.5 MT for ICS/LABA MDIs. CONCLUSION: Our study emphasizes the necessity of integrating environmental stewardship into healthcare practices. By fostering awareness and initiating discussions on sustainable practices, particularly in the context of pharmacy operations, we can contribute to a more environmentally responsible healthcare system while continuing to meet the clinical needs of our patients.

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