Environmental impact of inhaled medicines: A Thoracic Society of Australia and New Zealand position statement

Danielle F Wurzel; Brett D Montgomery; Natalie Anderson; Elena K Schneider-Futschik; Johnson George; Sinthia Bosnic-Anticevich; Emily Stone; Robert J Hancox; James Fingleton; Stephanie Kuek; Helen Tope; John Blakey

doi:10.1111/resp.14852

Environmental impact of inhaled medicines: A Thoracic Society of Australia and New Zealand position statement

Respirology. 2024 Nov 13. doi: 10.1111/resp.14852. Online ahead of print.

Authors

Danielle F Wurzel^{1

2}, Brett D Montgomery³, Natalie Anderson^{4

5

6

7}, Elena K Schneider-Futschik⁸, Johnson George⁹, Sinthia Bosnic-Anticevich¹⁰, Emily Stone¹¹, Robert J Hancox¹², James Fingleton¹³, Stephanie Kuek¹, Helen Tope¹⁴, John Blakey^{5

15}

Affiliations

¹ Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
² Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
³ General practice, Medical School, University of Western Australia, Perth, Western Australia, Australia.
⁴ Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.
⁵ Medical School, Curtin University, Perth, Western Australia, Australia.
⁶ Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia.
⁷ Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Western Australia, Australia.
⁸ Department of Biochemistry and Pharmacology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
⁹ Centre for Medicine Use and Safety & School of Public Health, Monash University, Melbourne, Victoria, Australia.
¹⁰ Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia.
¹¹ Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital Sydney School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹² Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand.
¹³ Te Whatu Ora-Capital Coast and Hutt Valley, Wellington, New Zealand.
¹⁴ Planet Futures, Melbourne, Victoria, Australia.
¹⁵ Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

PMID: 39536776
DOI: 10.1111/resp.14852

Abstract

Globally, more than 1.2 billion inhalers are purchased for asthma and chronic obstructive pulmonary disease (COPD) annually. In Australia and New Zealand, pressurized metered dose inhalers (pMDIs) are the leading delivery device prescribed and pMDI salbutamol can be purchased over the counter in Australia. These inhalers are a major contributor to healthcare related greenhouse gases. This is due to the propellants that they currently contain which have extremely high global warming potential (GWP). In this position paper, we report the findings of a Thoracic Society of Australia and New Zealand (TSANZ) working group on the environmental impact of inhaled respiratory medicines. We reviewed the use of inhaled medicines in Australia and New Zealand and their contribution to climate change and other environmental degradation. We propose strategies for health professionals and consumers to reduce environmental impact in the management of airway diseases. These include accurate diagnosis to avoid unnecessary treatment, better disease control to minimize the need for reliever therapy and actively choosing inhaler devices with lower environmental impacts when clinically appropriate. Inhaler selection should be tailored to the individual, aiming to achieve the best possible clinical outcome. Choosing an appropriate inhaler for an individual involves consideration of factors such as dexterity, inspiratory capacity and cost. In our current climate emergency and with the availability of lower carbon alternatives, health professionals should also consider environmental impact.

Keywords: COPD; air pollution; asthma; climate change; clinical respiratory medicine.