Letters Inhaled drugs and global warming

Cost of switching inhalers is high in carbon trading terms

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4162 (Published 02 July 2013) Cite this as: BMJ 2013;347:f4162
  1. Carl J Reynolds, core medical trainee1
  1. 1Royal Brompton Hospital, London SW3 6NP, UK
  1. carl.reynolds{at}openhealthcare.org.uk

The health risks from global climate change loom large,1 and actionable information about countermeasures is urgently needed.

Hillman and colleagues highlight the role of hydrofluorocarbons in metered dose inhalers (MDIs) as important greenhouse gases.2 They also note the variation in the proportion of inhalers that contain hydrofluorocarbons between the UK and Sweden. Our analysis using GP prescribing data for England and Wales (www.openprescribing.org/examples/hfc) also found considerable variation in the proportion of MDIs prescribed, from 70% (NHS Lincolnshire West) to 95% (NHS Islington).

However, the proportion of UK greenhouse gas emissions due to inhalers is small, and the cost of switching in carbon trading terms is high. Carbon dioxide is the main greenhouse gas responsible for global warming. The amount of global warming that a greenhouse gas causes is described by the functionally equivalent concentration of carbon dioxide (CO2 e).

Total greenhouse gas emissions in the UK in 2007 were 634.7 Mt CO2 e,3 and in 2012 UK emissions from MDIs were 1.6 Mt CO2 e.4 On this basis, MDI derived greenhouse gas emissions are responsible for about 0.25% of total annual emissions.

The traded carbon price was £14 (€16.5; $21.5) per tonne CO2 e in 2012.5 Assuming a hydrofluorocarbon content per inhaler of 17 g, and evaluating to 2025 using a discount rate of 3.5%, the estimated cost of reducing hydrofluorocarbon emissions from inhalers by 75% would be £174 per tonne CO2 e.4 Of course what is good for the economy is not necessarily good, and the argument for investing more in our environment and our health is not solely economic.


Cite this as: BMJ 2013;347:f4162



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