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Published on: April 6, 2017
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Inhaler sustainability in asthma and COPD care: a systematic review
Adeola Ayodotun Onasanya1, Yaser Haider2, Grace Peaston3,4
1Department of Applied Health Sciences, University of Birmingham, Birmingham, UK a.onasanya.1@bham.ac.uk.
BMJ Open
|July 25, 2025
Summary
Sustainable inhaler use in asthma and COPD requires better patient education on disposal and clinician training in low-carbon prescribing. This approach enhances health outcomes and environmental sustainability.
Area of Science:
- Environmental Health
- Respiratory Medicine
- Sustainable Healthcare
Background:
- Inhalers for asthma and Chronic Obstructive Pulmonary Disease (COPD) have significant environmental impacts.
- Current prescribing, usage, and disposal practices contribute to these environmental concerns.
- Limited awareness exists regarding the environmental footprint of inhaler management.
Purpose of the Study:
- To evaluate inhaler sustainability in asthma and COPD management.
- To analyze how inhaler design, prescribing, usage, disposal, and recycling influence health and environmental outcomes.
- To identify actionable opportunities for improvement using a People-Process-Product (PPP) framework.
Main Methods:
- A systematic review of literature published between April 2014 and April 2024 was conducted.
- Studies involving patients with asthma or COPD and healthcare professionals examining inhaler sustainability were included.
- Data were extracted and narratively synthesized using the PPP framework from 63 studies.
Main Results:
- Limited awareness of environmental impacts was found among patients and clinicians; over 75% of patients discarded inhalers in household waste.
- Switching to dry powder inhalers (DPIs) or soft mist inhalers (SMIs) improved adherence and asthma control, influenced by usability.
- DPIs and SMIs have lower carbon footprints than pressurized metered-dose inhalers (pMDIs), with short-acting beta-agonists (SABAs) pMDIs showing the highest emissions.
Conclusions:
- Enhanced patient education on sustainable inhaler use and disposal is crucial.
- Focused training for healthcare professionals on low-carbon prescribing is essential.
- These interventions are critical for improving clinical benefits and environmental sustainability in respiratory disease management.
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