Respiratory - Salbutamol Inhalers and the Environment

What is Salbutamol?

Salbutamol is a type of medicine which helps to relax muscles in the airways, making it easier to breathe.
It is found in reliever inhalers, used by people with conditions such as asthma and Chronic Obstructive Pulmonary Disease (COPD).

What are the different types of inhalers?

The main types of inhalers are dry powder (DPI) and metered dose (MDI).

Both are equally effective when used correctly1.

How do they differ?

DPIs do not contain a propellant (something that helps drive the medication into your lungs). This is better for the environment but requires the user to take a deep and fast breath to be effective.

MDIs contain a propellant, so are generally easier to use. However, this produces hydrofluorocarbons, a greenhouse gas that contributes to global warming.

Environmental Impact

The diagram below compares the carbon footprint of different salbutamol inhalers with that of average car journeys:

This means that switching to a salbutamol DPI could save 27kg of CO emissions, equivalent to travelling up to 90 miles in a car, for every inhaler used.

Switching all your inhalers to a DPI has a similar effect on your carbon footprint to eating a plant-based diet or avoiding all food waste. It reduces your carbon footprint by double that of effective recycling and is equivalent to planting 12 trees every year3.

Review, Reduce, Return

Changing inhalers isn’t the only way to reduce the environmental impact of inhaler use.

Here are some other ways:

Try to get your asthma or COPD under good control - The less you need to use a reliever inhaler, the smaller the carbon footprint. You can also improve your control by getting your vaccinations, stopping smoking and attending pulmonary rehabilitation (if appropriate to you).

Make sure you’re using inhalers correctly - This will give you better control of your asthma and may reduce the need for reliever.

Dispose of old inhalers at the pharmacy - as Propellant can leak out if left in landfill.

Avoid building up a stockpile - It’s important that you do not run out of inhalers, but if you have more than you need, speak to your GP/pharmacist.

Change to a lower emission MDI - If DPIs are not an option for you, there are some MDIs that produce less CO2.

FAQs

Here are some things to think about when deciding whether to change to a DPI.

Can I use a DPI?

Using a DPI involves taking a quick, deep breath over 2-3 seconds. Most people will be able to do this, but some with more severe disease may struggle. It’s best to get a healthcare professional to check your technique.

Scanning this QR code with your phone camera will take you to a video demonstrating different inhaler techniques.

Will this affect my asthma control?

If you are using the inhaler correctly (your respiratory nurse, pharmacist or doctor can check your technique), your asthma will be just as well controlled.

If I change now, can I go back to my old inhaler?

Yes, if you are finding it difficult to use the DPI, you can switch back to an MDI.

References

1. Woodcock, A. et al. (2022) Effects of switching from a metered dose inhaler to a dry powder inhaler on climate emissions and asthma control: Post-hoc analysis, Thorax.

Available at: https://thorax.bmj.com/content/77/12/1187

2. COPD management plan 2021 - GMMMG. Available at:

https://gmmmg.nhs.uk/wp-content/uploads/2021/11/COPD-  Treatment-Guideline-Nov-2021-V7.1.pdf

3. Janson C, Henderson R, Löfdahl M, et al (2020) Carbon footprint impact of the choice of inhalers for asthma and COPD, Thorax.

Available at: https://thorax.bmj.com/content/75/1/82

Interested in changing inhalers?

There is drive across Greater Manchester to switch over to DPI or lower carbon MDI inhalers where appropriate.
Your inhalers may have already been changed. However, if you would like to discuss switching over you can speak to:

• Your GP or practice COPD nurse
• A ward doctor
• A pharmacist
• Pennine Lung Service