Changing the type of inhaler prescribed to 2.6m Irish asthma patients could cut over 50,000 tonnes of carbon emissions a year, according to groundbreaking new research.
The report, led by Louth GP and former pharmacist Sean Owens, found the 4,427,287 inhalers dispensed in 2019 contributed 54,765 tonnes of CO2 equivalent to the country’s carbon footprint.
Metered dose inhalers, such as the popular Ventolin inhaler, account for 59% (2,608,433) of those given to asthma patients yet they also account for 97% of inhaler-related carbon emissions.
But Doctor Owens says switching those patients to more environmentally friendly dry powder (DPIs) or soft mist inhalers (SMIs) could also improve their health.
“Just one Ventolin has a carbon footprint similar to driving from Dublin to Tralee…an equivalent dry powder inhaler has a footprint of driving down to the local shop.
“Moving away from reliever inhalers to dual preventer and reliever inhalers for asthma has already been shown to be clinically effective, as per evidence base, the global asthma body GINA, as well as NICE, SIGN and ICGP guidance.”
“Overuse of Ventolin is a problem for health,” he told us.
“Using combination (steroid and reliever) inhalers has been shown to be superior for asthma control.
“In our practice when patients switch to more environmentally friendly dry powder inhalers they’re much better controlled... so it’s evidence-based for health, evidence-based for climate and then of course hospitals win because they are not seeing asthmatics in their EDs as frequently.
“It’s a really nice win-win-win - patient, climate, pocket - a bit like plant based diets, a bit like active transport.
“Why are we reimbursing ventolin when there’s a generic equivalent that’s half the carbon?
“That’s something the HSE should look at - let’s stop reimbursing the heavy polluter.”
“In terms of the one policy action the HSE could take, it would have to be to suspend PCRS reimbursement for Ventolin,” he continued.
“With the urgency of the climate crisis, we really need to decarbonise the carbon hot spots first and foremost.
“The seemingly innocuous blue reliever MDI is responsible for a significant proportion of the carbon footprint of the entire health service.”
Dr Owens’ report, published in the Irish Journal of Medical Science, concluded: “Targeting inhaler prescribing offers the potential to significantly improve the carbon footprint of Irish healthcare.
“Establishing the current carbon footprint of the inhalers that are prescribed, dispensed, and disposed in Ireland is a necessary baseline to inform moving towards a net zero health service.”
He is also a member of the Irish College of General Practitioners which has created a toolkit to help busy and time poor GPs cut emissions.
He says it “offers GPs, trainees, practice nurses and practice staff practical steps they can take to work towards a more sustainable future”.
“We believe primary care can be leaders in planetary health by lowering our own carbon, plastic, water, antibiotic and waste footprint and also by lessening the pressure on tertiary care, where much of healthcares emissions are to be found,” Dr Owens added.
“Furthermore, with healthcare’s trusted role, we hope healthcare can affect change at a political level by showing how the climate crisis is simultaneously a health crisis.
“Our other plans relate to coordinating with European colleagues through WONCA, EQuiP, the Planetary Health Alliance etc and by supporting Irish Doctors for the Environment advocacy and education, particularly with respect to inhalers.”
But he admits making the change will take time as they “need buy-in from all stakeholders including patients”.
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