Managing Inhaler Environmental Sustainability and Effective Respiratory Care: Current Evidence, Challenges, and Opportunities.

Growing global concern about climate change, alongside the widespread use of inhaler therapies, has intensified interest in the environmental sustainability of inhalers. The respiratory care community is increasingly focused on how to balance effective disease management with the need to avoid exacerbating environmental determinants of respiratory illness. Since Pharmaceutical Medicine last examined this topic in its article Sustainability in Inhaled Drug Delivery, the field has evolved rapidly, with notable developments. This Leading Article reviews the current evidence on the carbon footprints of inhalers and discusses strategies-along with their implications for patient care-aimed at reducing the environmental impact of inhaler therapies. We focus on strategies at the (a) health system level, including optimisation of respiratory care and inhaler choice, adherence, and technique, and (b) pharmaceutical industry level, including innovation and action related to next-generation lower-carbon propellants such as HFA-152a and inhaler circularity. While sustainability strategies exist, we acknowledge that progress is slow, and highlight key implementation, financial, and regulatory challenges that constrain their uptake. The article concludes by outlining recommendations to help support sustainable and effective respiratory care.