World Asthma Day, which takes place on the first Tuesday of May each year, is organised by the Global Initiative for Asthma to raise awareness and co-ordinate educational resources for the disease, which affects more than 350 million people worldwide.

According to Asthma UK, 5.4 million people in the country have the common chronic condition, characterised by recurrent attacks of breathlessness. These range in regularity and severity from patient to patient, with some experiencing symptoms several times a day while for others this is much rarer. This can be easily managed through the use of an inhaler, however the UK National Institute for Health and Care Excellence (NICE) has now issued guidance assessing the carbon footprint of the devices – and it’s not good news.

Metered dose inhalers: an outsized carbon footprint

The most popular type of inhaler in the UK is a metered dose inhaler (MDI). However, NICE is now recommending that, where possible, asthmatic patients cease using these devices.

MDIs made up 70% of inhaler sales in the UK in 2011, compared with less than half in many other European countries, and less than 10% in Sweden.

Unfortunately, considering their prolific use in the UK, they contain propellants called hydrofluorocarbons (HFCs), which are powerful greenhouse gases (GHGs). MDIs have an estimated carbon footprint of 500g per dosage.

The HFC content of an MDI means that five doses from one of the devices has equivalent GHG asthma inhaler emissions to a nine-mile car journey. The devises usually contain 100 doses, meaning a used-up MDI will typically have the same environmental impact as a 180-mile car journey.

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NICE has now released a new patient decision aid which aims to help patients assess their options and potentially switch to a more environmentally friendly option, in the hopes this could help to cut the health sector’s carbon footprint.

NICE deputy chief executive Professor Gillian Leng said: “People who need to use metered dose inhalers should absolutely continue to do so – but if you have the choice of a green option, do think about the environment. Cutting carbon emissions is good news for everyone, especially those with respiratory conditions.”

Is a mass inhaler switch practical?

While not all patients will be able to move away from MDIs, the NICE guidance suggests that more could. Dry powder inhalers (DPIs) have only 20g of carbon dioxide per equivalent dose compared to an MDI’s 500g, drastically reducing the carbon footprint of each puff. However, these are only recommended for people with milder attacks, meaning patients with severe asthma are less likely to be unable to make the change.

James Barber, a British asthma patient and MDI user, says: “If I can make a small change that will have even a minor impact on my carbon footprint, then I should be doing everything I can to enact that change. I actually wasn’t aware at all of how significant my inhaler usage could be on the environment until these guidelines were released, or even that there more environmentally friendly inhalers available, so it’s been a real eye-opener.

“I’ve looked into alternatives and I’ll be seeing if I can switch to a DPI which has less of an impact whilst still providing me with the relief I need.”

It is unclear what the practical implications for a mass switch over would be – at the time of writing, both the NHS and NICE were unable to provide figures on the cost of MDIs versus DPIs for the health service. Should a substantial number of British MDI users request a switch to a DPI for environmental reasons, more of these would need to be manufactured to keep up with the new demand, which could have a direct impact on the cost to the NHS of procuring asthma medications.

NHS Trusts are often able to facilitate the treatment path of choice for patients, meaning it is well-placed encourage an environmentally-motivated switch from MDI to DPI for a lot of people.

English asthma patients are able to collect their inhalers for £9 each under NHS prescription charges, or enrol in a pre-payment scheme, while patients in Scotland, Wales and Northern Ireland are able to receive them free of charge.

Complications for asthmatics with private insurance

However, this may not be so easy for international asthma sufferers, due to complications with private health insurers.

Heather Mullins, an asthmatic who lives in Florida, says: “As someone on these meds, trust me it’s hard enough to get them when you need them in America. I have two different kinds of inhaler, a daily and a rescue, and I had to fight my insurance twice over it.

“I figure most people would switch to a more eco-friendly version, but it has to be accessible and insurance has to work with it. I know mine barely wants to cover what I already need, let alone if I want to get picky about it.”

Regardless of carbon footprint, inhaler users have been advised to stick to the device which works best for them – even if it isn’t the most eco-friendly option.

Asthma UK director of research and policy Dr Samantha Walker says: “Asthma attacks are not only terrifying but they can be life-threatening. It is vital that people with asthma have the inhaler that best suits their needs, and which will help to keep them well.

“If anyone is thinking about changing their inhaler or needs advice, we recommend that they visit their GP or asthma nurse.”