ReviewThe European respiratory journal2022
The environmental impact of inhaled therapy: making informed treatment choices.
Review in The European respiratory journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
42 citing papers in PubMed, 3 syntheses or guidelines pooled it, 77 citations in OpenAlex.
- Efficacy and safety of different inhaler types for asthma and chronic obstructive pulmonary disease. a systematic review and meta-analysis.NPJ primary care respiratory medicine · 2026Pooled it
- Clearing the air: a systematic review on leadership challenges with sustainable inhaler prescribing.BMJ leader · 2025Pooled it
- Strategies and tactics to reduce the impact of healthcare on climate change: systematic review.BMJ (Clinical research ed.) · 2024Pooled it
- 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
- Patients' perspectives in German general practice on discussing the environmental impact of medications: A qualitative study.The European journal of general practice · 2026Article
- Fucose-tobramycin sponge-like microparticles to treat pulmonary Pseudomonas aeruginosa infections in a lectin-competitive approach.Journal of advanced research · 2026Article
- Behaviour change intervention for inhaler disposal, Spain.Bulletin of the World Health Organization · 2026Article
- Educational Intervention on Environmentally Responsible Inhaler Prescribing Among French General Practitioners: Pilot Pre-Post Study.JMIR formative research · 2026Article
- Environmental Advocacy by the American College of Emergency Physicians: A Brief History of Climate and Sustainability Resolutions.The western journal of emergency medicine · 2026Article
- Addressing the Global Challenges of COPD and Asthma: A Shared Vision From the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) and the Global Initiative for Asthma (GINA).Respirology (Carlton, Vic.) · 2026Article
- Rationale and Strategy for Switching to an All-Nebulization Protocol for In-Hospital Administration of Respiratory Medications.Hospital pharmacy · 2026Article
- South African Thoracic Society position statement on asthma in children, adolescents and adults.African journal of thoracic and critical care medicine · 2026Article
- Salbutamol Reversal of Methacholine Induced Bronchoconstriction: Vibrating Mesh Nebulizer versus Pressurized Metered Dose Inhaler.Journal of asthma and allergy · 2026Article
- Air pollution, inhaled therapy and COPD exacerbations in Yunlin, Taiwan: a 2016-2024 single-centre retrospective cohort with environmental and carbon-footprint analyses.BMJ open respiratory research · 2025Observational
- Environmentally friendly inhaler decision-making with personalized care in asthma and chronic obstructive pulmonary disease: a qualitative study.Exploratory research in clinical and social pharmacy · 2025Article
- Deconstructing Therapeutic Failure with Inhaled Therapy in Hospitalized Patients: Phenotypes, Risk Profiles, and Clinical Inertia.Biomedicines · 2025Article
- Inhaler use and their carbon footprint in Germany: a 10-year analysis (2013-2022).BMJ open respiratory research · 2025Article
- 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
- Article
- Resultant greenhouse gases from the use of inhaled corticosteroid based on Global Initiative for Asthma (GINA) guidelines: a primary care used case from Singapore.NPJ primary care respiratory medicine · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 7 institutions in 6 countries.
Funding
Abstract
When selecting the best inhaler and drug combination for a patient with respiratory disease, a number of factors should be considered. While efficacy and safety of medical treatments are always a priority, in recent years the environmental impacts of all aspects of life have become an increasingly necessary consideration and inhaled therapies are no exception. The carbon footprint of an item, individual or organisation is one of the most important and quantifiable environmental impacts, assessed by the amount of greenhouse gases (often expressed in terms of carbon dioxide equivalents) generated throughout the life cycle. The two most commonly prescribed and manufactured inhaler types worldwide are pressurised metered-dose inhalers (pMDIs) containing hydrofluorocarbon (HFC) propellants and dry powder inhalers (DPIs). Most of the carbon footprint of current pMDIs is a result of the propellants that they contain (HFC-134a and HFC-227ea, which are potent greenhouse gases). In comparison, the powder in DPIs is dispersed by the patient's own inhalation, meaning DPIs do not contain a propellant and have a lower carbon footprint than most pMDIs currently available. Soft mist inhalers are another propellant-free option: the device contains a spring, which provides the energy to disperse the aqueous medication. In this review, we examine the published data on carbon footprint data for inhalers, providing an analysis of potential implications for treatment decision making and industry initiatives.
Indexed as
Identifiers
What OpenQuestion holds
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.