Study: Inhalers for asthma and COPD come with a steep environmental cost

Inhalers are the frontline treatment for asthma and COPD, but they come with a steep environmental cost, according to a new UCLA Health study - the largest to date quantifying inhaler-related emissions in the United States.

Researchers found that inhalers have generated over 2 million metric tons of carbon emissions annually over the past decade, equivalent to the emissions of roughly 530,000 gas-powered cars on the road each year.

The study, published in JAMA, analyzed emissions from the three types of inhalers approved for asthma or COPD from 2014 to 2024. It found that metered-dose inhalers were the most harmful to the environment, accounting for 98 percent of emissions over the ten-year period. Metered-dose inhalers contain hydrofluoroalkane (HFA) propellants, which are potent greenhouse gases that were widely used in products such as aerosol sprays. The other types of inhalers, which include dry inhalers and soft powder mist inhalers, are less harmful to the environment as they deliver medication to the lungs without the need for propellants.

Inhalers add to the growing carbon footprint of the US healthcare system, putting many patients with chronic respiratory disease at risk. On the upside, there is tremendous opportunity to make changes that protect both patients and the planet by utilizing lower-emission alternatives."

Dr. William Feldman, pulmonologist and health services researcher at the David Geffen School of Medicine at UCLA, and study's lead author

Researchers conducted the study using a comprehensive U.S. database capturing inhaler prescriptions at the National Drug Code (NDC) level. Emissions were then estimated using validated academic studies and analyzed by drug type, device type, propellant type, therapeutic class, branded status, manufacturer, payer, and pharmacy benefit manager.

Researchers plan to expand their research to examine inhaler-related emissions in specific patient populations, such as the Medicaid population. They will also compare clinical outcomes between of lower- and higher-emission inhalers in the same therapeutic class and explore pricing and patenting strategies that pharmaceutical companies may use as they roll out lower-emission inhaler technologies. 

"A key first step to driving change is understanding the true scale of the problem," Feldman said. "From there, we can identify what's fueling these emissions and develop targeted strategies to reduce them-benefiting both patients and the environment."