Guideline on climate conscious prescription of inhaled medication

Guido Schmiemann, Michael Dörks, Christian Grah

Keywords: Asthma; COPD; greenhouse gases

Introduction:

In Germany, the healthcare system is responsible for approximately 5% of CO2 emissions. The primary contributors to the carbon footprint in healthcare stem from various sources, with the largest proportion attributed to the prescription of medications. Following closely behind are emissions associated with mobility (both patients and staff) and heating.
One specific area of concern relates to the treatment of asthma and chronic obstructive pulmonary disease (COPD), which often involves the use of different types of inhalers. The impact of these inhalers on climate change varies depending on their mode of action. Broadly, inhaled medications fall into two categories: metered-dose inhalers (MDIs) and dry powder inhalers (DPIs).
MDIs, due to their propellants, have a significant potential for harming the atmosphere in terms of global warming (measured by global warming potential - GWP). For instance, in the United Kingdom, metered-dose inhalers account for as much as 3.5% of greenhouse gas emissions from the entire UK healthcare system. Transitioning to more environmentally friendly DPIs can lead to a substantial reduction in greenhouse gas emissions without compromising the management of asthma.

Method:

This guideline was developed based on recommendations provided by the Standing Guideline Commission of the Association of Scientific Medical Societies in Germany (AWMF). The development process involved multiple consensus conferences with specialists from relevant fields, including pediatrics, pulmonology, pharmacy, and patient representatives. These conferences were expertly moderated by the AWMF

Results:

In February 2024, the interdisciplinary guideline was officially released by the AWMF, with an English version set to become available shortly. The acceptance and implementation barriers will be assessed through practical tests in healthcare settings

Conclusions:

Addressing the impact of medication on global carbon footprint can be an example to discuss the environmental impact in daily practice

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