Best for the planet and the patient – What to know about the environmental impacts of asthma and COPD care

Facts | 5/16/2023
Best for the planet and the patient – What to know about the environmental impacts of asthma and COPD care
How sustainable is your inhaler? Respiratory specialist, Professor Christer Janson’s ground-breaking study on the environmental impacts of asthma and COPD treatments, has revealed some surprising results.

With climate change now one of the most pressing issues of our time, people everywhere are taking action to reduce their carbon footprints, or their personal contribution to the global greenhouse gas emissions that cause climate change. Some of these actions include changing your lightbulbs to sustainable LED lights, switching to a cold-water laundry wash, leaving your car at home to take public transport, or, as Professor Christer Janson, from Uppsala University Hospital, Sweden, discovered, for people with asthma, it could even be an action as simple as changing to a different type of inhaler.

It was in late 2017, when Janson first stumbled across the data behind his pioneering research. After reading the full report,” Janson recalls, “I knew I had to do something with this!”

The data showed that the propellants used in pressurised Metered Dosed Inhalers (pMDI) for asthma and COPD treatment contain a green-house gas that is 1,300 times more potent than carbon dioxide.

“That means that even the very tiny amount of propellant gas that goes into each metered-dose inhaler was making a very sizeable contribution to global green-house gas emissions,” Janson says.

Concerned by this, Janson and his team started comparing different asthma and COPD sprays and types of inhalers and their carbon footprint.

While most of the work going into this peer-reviewed study was done in 2018, it was published in 2020, and since then a number of other publications have come out in support of Janson’s findings. 

The study found conclusively that using pMDI inhalers was significantly more impactful on the environment than using dry powder inhalers, or DPIs, which do not use any greenhouse gas-generating aerosols to release each dosage.


Professor Christer Janson’s research shows how for most patients the same asthma control can be gained with much less environmental impact by using a dry powder inhaler.

Counting carbon

According to Janson, the average carbon footprint for a person using a pMDI twice a day for one year totalled half a tonne of CO2, compared with using a DPI, which has a comparatively miniscule carbon count of close to zero.

To put that in context, the difference in terms of avoided carbon emissions is the annual equivalent of one person eating a meat-based diet daily compared with being a vegetarian.

“So quite a large effect,” Janson enthuses.

Best care for you

But of course, human health must come first. That’s why Janson urges people using inhalers to treat their asthma or COPD only to consider switching to a DPI if it is recommended by a health care professional as the right treatment option. However, for most patients with asthma or COPD, the effect of taking medication through either an MDI or a DPI is the same.  

“There is no difference,” Janson says, “And that is true for at least 90% of inhaler users. So, if it happens that the DPI is right for you, then switching makes good sense for your health and for the planet.”  

Better control

DPIs are not suitable for very small children or for older people with asthma or COPD who can’t manage treatment on their own – where pMDI together with spacers are the best options. At the moment, MDIs with spacers are also the preferred option when giving bronchodilators at the Emergency Room, for the treatment of severe asthma or COPD exacerbations.

Reliever treatment with bronchodilators can be given both with DPIs and MDIs, but in many countries reliever treatment with MDIs dominates. That means the less asthma control you have, the more reliever therapy you will need, which will increase the carbon footprint. Or put another way, the better your asthma control is, the better it is for the environment.

Of course, the bulk of this comparison centres around the environmental impacts of the use phase of inhalers. In a full life-cycle analysis, there are other phases to consider including manufacturing and transportation of inhaler products. However, according to Janson these are so miniscule and the climate effect of the use-phase propellants is so great that, comparatively, they become almost irrelevant.

Other critics have said that with the overall footprint of the pharmaceutical industry not nearly as big as heavy hitting industries like electricity, transportation, cement, what is the point?

But I don’t work in those industries,” Janson says, “And I want to find reductions where I can, in my own sphere of influence, while maximising the good health of patients and minimising global impacts.”

Are you ready to switch to a more sustainable inhaler?

If you are using a measured dose inhaler (MDI) and want to shift to an eco-friendly dry powder inhaler (DPI):

  • First, consult your doctor or health professional to ensure that a DPI is the best treatment choice for you.
  • Do not stop using your current inhaler until you have confirmation that DPI is right for you since it may impact your asthma control.

Source: British Thoracic Society (BTS) Position Statement on The Environment and Lung Health 2020

By Laurel Colless

Photo by Adobe Stock


Janson C, Henderson R, Löfdahl M, et al Carbon footprint impact of the choice of inhalers for asthma and COPD Thorax 2020;75:82-84.

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Orion invests in research and development of treatment options for people with asthma and COPD while also developing the design and usability of the Easyhaler® inhaler device platform. The focus is on safety and quality in each step of the product life cycle while taking care of the environment. All aspects of sustainability - social, economic and environmental - are carefully considered in the whole product life cycle. Sustainability is entwined in the whole process from R&D through manufacturing, including patient use and the disposal of old inhalers.

You can download the Orion Sustainability Report 2021 here