Climate- conscious prescription of inhaled medications : DEGAM S1-Guideline

The health care system is responsible for about 5 % of carbon dioxide (CO2) emis-
sions. The biggest contributor to the carbon footprint caused by ambulatory primary care is the prescription of medications, followed by emissions from transportation (of patients and staff) and heating.
Medication for chronic obstructive airway diseases (inhalers) is of special importance regarding the carbon footprint of the health care sector.
The extent to which these inhalers contribute to climate changes varies depending on their method of functioning.
The two main categories of inhalers are dry powder inhalers and metered-dose inhalers.
Dry powder inhalers (DPIs) contain an active substance in powder form. The active ingre-
dient is released and distributed by inhalation, requiring a sufficiently strong inhale to ensure effective therapy.
In contrast, metered dose inhalers (MDIs) use propellants to transport the active substance
into the deep sections of the lungs.
The chlorofluorocarbons (CFCs) that were used as propellants for MDIs in the past have been largely banned due to their impact on the ozone layer and have been replaced by
hydrofluoroalkanes (fluranes). While these do not damage the ozone layer, they are pow -
erful greenhouse gases. Compared with DPIs, MDIs therefore have more potential to damage the atmosphere (global warming potential - GWP).

This guideline aims to support a shift in prescribing patterns of inhalers to reduce the carbon footprint of the health care system. It addresses those involved in prescribing inhalers and counselling patients with asthma/COPD. This includes doctors and their practice teams as well as pharmacists and other health professionals.
The guideline supports climate-conscious prescription of inhalers by
n summarising existing evidence on the decision between DPIs and MDIs
and explicitly addressing the climate damage caused by propellants.