Assessment of Combination Long Acting Beta Agonists (LABAs) and Inhaled Corticosteroids(ICS) Part 2
We continue our journey to transform Respiratory care to the lowest possible carbon impact by looking at
Combination LABA plus ICS inhalers this month. Chlorofluorocarbons (CFCs) inhaler propellants contained
in pMDIs (pressurised Metered Dose Inhaler) were recognised as ozone depleting substances and were
phased out in the UK by 1996. CFCs were replaced by ‘CFC-free’ inhalers containing hydrofluorocarbons
Although HFCs are not ozone depleting substances, they are powerful greenhouse gases which can
contribute to global warming. Carbon emissions from inhalers have been assessed as being responsible
for approximately 3% of all NHS carbon emissions.
The NICE patient decision aid gives an indicative range for DPI (Dry Powder Inhalers) and pMDIs:
- DPIs (1 dose (two puffs)): 20 g CO2e per dose
- pMDIs (two puffs): 500 g CO2e per dose
This is, unfortunately, not the full story, as some pMDIs have a higher indicative carbon footprint when
compared with other pMDIs.
Even though the Environmental Sustainability indicators have been removed from the Investment and
Impact Fund (IIF) 2023/24 Incentive scheme, there is still a great need to reduce the carbon footprint of inhalers.