Respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, affect millions of people around the world and are a considerable burden to health-care services1,2,3. Notably, as the climate crisis intensifies, patients with respiratory diseases will be disproportionately affected by the associated environmental factors4,5,6.
“The lungs are the only internal organ that is continuously and directly exposed to the environment,” says Job van Boven, pharmacist and associate professor of cost effective and sustainable respiratory medicines use at the University Medical Center Groningen in the Netherlands. “This means our lungs and airways are vulnerable to rising pollution, allergens and temperatures.” Consequently, the number of people with chronic respiratory diseases will probably rise as the effects of global warming take hold6.
Health-care systems face significant challenges in dealing with respiratory diseases. In the process of providing essential care for patients, they also contribute to greenhouse gas emissions through doctor and hospital visits, as well as medicine use7. The less controlled a patient’s disease is, the higher their use of health-care resources8,9.
To help address these challenges, clinicians should start by optimizing disease management through guideline-directed treatment, thus improving patient outcomes. In parallel, the environmental impact of inhaled medicines will be reduced by the upcoming transition to pressurized metered-dose inhalers (pMDIs) with a lower global warming potential (GWP)8.
The carbon footprint of respiratory care
Poorly controlled respiratory disease increases a patient’s carbon footprint as they require more doctor visits, rescue medicines use and hospitalizations8,9.
In particular, asthma patients with poorly controlled disease may have a carbon footprint up to three times higher than those with well-managed disease9. In the United Kingdom, poorly-controlled asthma is estimated to generate emissions equivalent to more than 300,000 tonnes of CO2 annually — comparable to emissions from more than 124,000 homes (based on 2020 data)8,9.
“A patient who is stable long term uses fewer resources and has less impact on the environment than an unstable patient,” says Van Boven.
In respiratory care, a green patient is one whose condition is well controlled. Implementing evidence-based guidelines is a powerful way to achieve disease control, prevent exacerbations and hospitalizations, and consequently reduce the overall carbon footprint of care8.
The risks of switching inhaled medicines
Inhaled medicines delivered by pMDIs are the most common medicines used in respiratory care — accounting for 78% of global inhaler use10 — and are an essential therapeutic option for many patients11. These inhalers use a propellant gas to deliver the medicines directly to the lungs, making them especially critical for many patients who may struggle with the specific forceful inhalation technique required by other devices12.
Inhaled medicines are also available in devices that do not use a propellant, but the medicines and devices are typically not interchangeable; switching inhaled medicine regimens for non-clinical reasons risks having a negative impact on patient outcomes13. Patients and clinicians need access to a full range of options to ensure treatments are tailored to individual clinical needs8,12.
“Treatment selection should always be informed by discussion between a patient and their health-care provider — and focused primarily on clinical outcomes and what the patient can and will use,” says Franziska Trudzinski, senior consultant in pneumology and respiratory critical care medicine at Heidelberg University Hospital, Germany. “Clinicians and patients should never feel like they have to choose between the most appropriate treatment and the planet.”
Trudzinski emphasizes the importance of putting the patient’s needs first. “As health-care professionals, we have an ethical obligation to do what is best for every individual in our care,” she says.
Choosing the right respiratory medicine should be a shared decision between clinicians and patients, based on clinical need. To support informed choices, patients need clear, accessible information about each treatment option — including the benefits and limitations of different medicines and devices. Crucially, before changing medicines or device types, a clinician must ensure the patient can use the new device correctly to maintain effective disease control and encourage adherence12.
Inhaled medicine innovations
When it comes to respiratory care, emerging research shows that the highest greenhouse gas emissions are associated with inpatient care and primary care – greenhouse gas emissions tend to increase by exacerbation frequency and/or severity14. Reducing these emissions will involve commitment from all stakeholders, including biopharmaceutical companies, health-care providers, policymakers and patients. As for pMDI use, which represents less than 0.04% of all global greenhouse gas emissions15, that too can now be addressed.
Scientific advances are accelerating the transition to inhaled medicines with lower GWP. The first inhaled respiratory medicine delivered by a pMDI using a next-generation, ‘near-zero’ GWP propellant has recently been approved and will be available to patients in the UK and Europe in the coming months16,17. This propellant offers 99.9% lower GWP than propellants used in currently available pMDIs18.
“pMDIs with next-generation propellants could be a good alternative option for clinicians,” says Trudzinski. “They will provide patients with the same medicines, using the same inhaler technique that they are used to, but with a far lower carbon footprint.”
Van Boven agrees about the potential benefits of combining a new propellant with existing inhaled respiratory medicines. “Effective disease control is the priority, for both patients and the environment. Optimal patient care remains our primary goal,” he concludes. “Ongoing access to all inhaler types is essential to achieve this.”
Veeva ID: Z4-76801. September 2025.
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