The Climate is Changing for Metered-Dose Inhalers and Action is Needed

Area of Science:

• Environmental Science
• Pharmaceutical Science
• Public Health

Background:

• Hydrofluorocarbon (HFC) propellants in metered-dose inhalers (MDIs) have high global warming potential (GWP).
• Global regulations like the Montreal Protocol mandate phasing down HFCs, prompting a shift towards dry powder inhalers (DPIs).
• Pressurized metered-dose inhalers (pMDIs) are crucial for certain patient populations and acute conditions.

Purpose of the Study:

• To analyze the economic feasibility of switching respiratory medications from pMDIs to DPIs across major global markets.
• To assess the clinical necessity of maintaining pMDI availability for specific patient demographics and conditions.
• To explore the financial implications of HFC phase-down on pMDI propellant costs and medication affordability.

Main Methods:

• Analysis of top 15 respiratory drug markets by drug class.
• Review of clinical evidence regarding patient usability of DPIs versus pMDIs.
• Economic modeling of medication costs under different propellant scenarios.

Main Results:

• Switching to DPIs is economically viable for most drugs, but not for short-acting beta-agonists (reliever medications).
• A significant portion of patients, including the very young, elderly, and those with acute exacerbations, require pMDIs.
• Projected 2025 propellant cost increases for pMDIs may render reliever medications unaffordable in some markets.

Conclusions:

• Both pMDIs and DPIs are clinically and economically necessary for respiratory care.
• Developing new pMDI formulations with lower GWP propellants (e.g., HFC 152a, HFO 1234ze(E)) is critical.
• Urgent action is needed by pharmaceutical companies to adapt to regulatory changes and ensure medication accessibility.