Inhaler use and their carbon footprint in Germany: a 10-year analysis (2013–2022)

Abstract

Background Inhalers are essential for managing asthma and chronic obstructive pulmonary disease; however, their environmental effects vary significantly. Pressurised metered-dose inhalers (pMDIs) contain potent greenhouse gases (GHGs), resulting in a much higher carbon footprint (CF) than non-propellant inhalers (NPIs). Consequently, reducing the use of pMDIs is seen as an important contribution to reduce the healthcare sector’s effect on climate change. This study analyses inhaler dispensing trends in Germany, estimates their resulting CF and quantifies the potential GHG savings from increased NPI use.

Methods Dispensing data at the expense of statutory health insurances, covering nearly 90% of the German population, were analysed from 2013 to 2022 across three age groups. Annual dispensing shares and CF estimates based on life cycle assessment-derived CF values were calculated for four inhaler types: pMDIs with hydrofluorocarbon (HFC)-134a, pMDIs with HFC-227ea, dry powder inhalers (DPIs), and soft mist inhalers (SMIs). Two scenario calculations estimated the potential GHG savings.

Results Between 2013 and 2022, the total number of dispensed defined daily doses of inhalers increased by 14%, with no significant shift towards lower-emission inhalers (2013, 55% NPIs; 2022, 52% NPIs). Consequently, the total CF increased from 459 kilotonnes of carbon dioxide equivalent (kt CO2eq) in 2013 to 525 kt CO2eq in 2022 (+14%). More than 95% of the inhaler-related CF was attributable to pMDIs. A GHG-saving scenario assuming 85% NPI use among patients aged 10–79 years projected an annual CF reduction of 55% (288 kt CO2eq).

Conclusion Despite climate neutrality goals, inhaler-related CF has continued to rise because of stable pMDI usage rates. The substantial potential for GHG reduction highlights the necessity and feasibility of a sustainable change in clinical prescription practice. Our insights could support the promotion of climate-friendly inhalers across other European countries with similar prescription patterns.