Which inhalers are kindest to the environment?

Nick Hopkinson, our medical director, explains what inhaler users can do to help the environment.

New advice from the National Institute for Clinical and Healthcare Excellence (NICE) encourages health care professional and patients to think about the environment when choosing and using inhalers

This is sensible, and you shouldn’t worry if you use inhalers.

There is no doubt climate change is happening and it’s being driven by greenhouse gas emissions. If we do not take steps to address it now the effects already being felt will get worse.   

There are many mechanisms that make climate change especially bad for lung health. These include poorer air quality, forest fires, increases in pollen levels and moulds as well as difficulties coping with direct effects of heat.

Inhalers produce greenhouse gases, but are not dangerous for the user

Joan using a pDMI inhaler
Using a pressurised metred dose inhaler (pMDI)

Some inhalers use propellants to create a spray of medication droplets which the person inhales. These are called pressurised metred dose inhalers (pMDIs).

The propellants in pMDIs are a powerful greenhouse gas. They are safe for the person using them but they have a much bigger impact on the environment than dry powder inhalers (DPIs) delivering the same medicine. That’s because DPIs, like Ellipta, Accuhaler, Breezhaler and Genuair, don’t use propellant gases. 

The UK is unusual for having such a high proportion of pMDI inhalers compared with other countries. There are more than 65 million inhalers prescribed by the NHS every year. While a single inhaler doesn’t have that much impact, combined they soon add up.

For most people, either type of inhaler is equally effective

Joan using a DPI inhaler
Using a dry powder inhaler

The thrust of NICE’s guidance is where someone can use a DPI effectively to deliver the same medication, then that should be the preferred option.

If you use an pMDI it may be worth discussing your treatment with your doctor or respiratory nurse to see if changing would be a good idea.

If you do change, you probably won’t notice any difference in your symptoms. If there is any worsening you can change back again. If you do need to carry on using an pMDI don’t worry, the point of the guidance is to make sure fewer people are using this kind of inhaler unnecessarily. 

No one will be prevented from using what they need to get the best control of their lung disease.

It’s really important to use your inhaler effectively - make every puff count

The other thing that’s really important if you are using an pMDI or any inhaler is to make sure you are using it properly. Some people who are using lots of puffs on their inhaler do this because they aren’t using them properly. 

Remember, with a metered dose inhaler you need to take a slow breath in (about 4 seconds) with each puff not a sharp fast breath. Slow down, and make every puff count.

Our friends at Asthma UK have produced videos showing how to use the different types of inhaler.

Recycle your inhaler

Finally, return all your used inhalers to your pharmacist for recycling. Some pharmacists have recycling bins for inhalers. Recycling makes sure once you’ve finished with it, any leftover propellant gas in the inhaler doesn’t get released into the environment as well as ensuring the metal and plastic can be reused where possible.


Nick Hopkinson

Dr Nicholas Hopkinson

Nick is our medical director, reader in respiratory medicine at Imperial College and consultant physician at Royal Brompton Hospital.

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14 May 2019