ArticleDrug design, development and therapy2020
The Climate is Changing for Metered-Dose Inhalers and Action is Needed.
Article in Drug design, development and therapy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 99 citations in OpenAlex.
- Developing low-carbon salbutamol MDI: assessment of relative bioavailability and pharmacodynamic relative potency of salbutamol MDI with propellant HFA-152a.BMJ open respiratory research · 2026Trial
- Bioequivalence of budesonide/glycopyrrolate/formoterol fumarate with a next-generation propellant versus hydrofluoroalkane-134a in healthy adults: phase I, randomized, double-blind, single-dose, partial-replicate, three-way cross-over lung exposure and total systemic exposure studies.Therapeutic advances in respiratory diseaseTrial
- Reducing healthcare emissions in the United States in the era of federal environmental deregulation: established and emerging mitigation opportunities and concomitant benefits.BMC global and public health · 2026Review
- Decarbonising Respiratory Care: The Impact of a Low-Carbon Salbutamol Pressurised Metered-Dose Inhalers.Allergy · 2026Article
- Climate change and respiratory health: implications for respiratory clinicians in primary and specialist care.NPJ primary care respiratory medicine · 2026Review
- Estimation of carbon emissions from inhaled respiratory medicines in Ireland: a cross-sectional study from a national pharmacy claims database from 2020 to 2022.International journal of clinical pharmacy · 2026Article
- South African Thoracic Society position statement on asthma in children, adolescents and adults.African journal of thoracic and critical care medicine · 2026Article
- Environmental sustainability in asthma: reducing carbon footprint and medication wastage.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2025Article
- The role of environmental impact in healthcare providers' choices of inhalers for treatment of asthma and COPD: a discrete choice experiment.BMC primary care · 2025Article
- Article
- Trends in inhaler use and associated carbon footprint: a sales data-based study in Europe.BMJ open respiratory research · 2025Article
- Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based study.Lancet regional health. Americas · 2025Article
- How to move towards more sustainable asthma care in Europe: an expert opinion paper.Breathe (Sheffield, England) · 2025Article
- Environmental impact of inhaled medicines: A Thoracic Society of Australia and New Zealand position statement.Respirology (Carlton, Vic.) · 2025Review
- Pharmaceutical, Clinical, and Regulatory Challenges of Reformulating Pressurized Metered-Dose Inhalers to Reduce Their Environmental Impact.Journal of aerosol medicine and pulmonary drug delivery · 2025Review
- In-vitro Evaluation of Solution Pressurised Metered Dose Inhaler Sprays with Low-GWP Propellants.Pharmaceutical research · 2025Article
- Article
- Use of metered dose inhalers for bronchodilator responsiveness testing: laboratory practices in Australia and opportunities for carbon footprint reduction.BMJ open respiratory research · 2024Article
- The Need to Emphasize Inhaler Education in Residency and Fellowship Training in the Era of Climate Change.Journal of graduate medical education · 2024Article
- Contributions of Medical Greenhouse Gases to Climate Change and Their Possible Alternatives.International journal of environmental research and public health · 2024Review
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Increases in global temperature are already having a significant impact on our climate. The hydrofluorocarbon (HFC) propellants used today in pressurized metered-dose inhalers (pMDIs) have global warming potential (GWP) many times that of carbon dioxide. Their use, together with all other emissive uses of HFCs, is being phased down under the Montreal protocol. This has prompted calls to switch patients to dry powder inhalers (DPIs). This paper presents a new analysis of the top 15 respiratory drug markets by drug class. It shows that a switch to DPIs would be economically feasible for most countries and most drugs. However, a wholesale switch of reliever medications, notably short-acting β-agonists, would lead to significant increases in the cost of these life-saving medications. Reviewing the evidence, whilst most patients are capable of using DPIs, the very young, very old and those undergoing an acute exacerbation still require a pMDI. Thus, there is a clinical and economic need to have both pMDIs and DPIs available. At the same time, it is projected that the reduction in non-medical uses of propellants is likely to give rise to a 5-fold increase in their cost for pMDI uses and is likely to hit the Western world in 2025. This may lead to a price increase in reliever medication that will make it unaffordable for the poorer communities in some markets. At the same time, opportunities to save money by developing new formulations using propellants with lower GWP, such as HFC 152a or HFO 1234ze(E), are described. Two companies have made this commitment, but neither currently have a strong presence in reliever medication. For them, or other companies, now is the time to act; 2025 is not far away in terms of product development timescales and the climate cannot wait.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.