Reducing the carbon footprint of inhaler prescriptions at an Australian tertiary health service: a modelling exercise
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Background
Climate change poses significant health risks, particularly for respiratory patients. Healthcare systems contribute substantially to greenhouse gas emissions, with inhalers representing a notable source. Metered dose inhalers contain hydrofluorocarbons with global warming potentials 1,300-3,350 times that of carbon dioxide, while dry powder inhalers and soft mist inhalers have negligible emissions. Despite guidelines recommending environmentally friendly alternatives, limited data exists on Australian hospital discharge prescribing patterns and their environmental impact.
Methods
We conducted a retrospective descriptive study of all inhaler prescriptions at discharge from Western Health, Victoria, from January 1 to December 31, 2023. De-identified prescription data were extracted from electronic medical records without exclusions. We calculated total prescriptions by device type and medication class, estimated carbon emissions using published propellant data, and modelled potential emission reductions from switching metered dose inhalers to dry powder inhalers where clinically appropriate. Scenarios included 10%, 50%, 85%, and 100% conversion rates.
Results
Of 16,769 inhaler prescriptions, 71.87% were metered dose inhalers, 22.11% dry powder inhalers, and 6.02% soft mist inhalers. Short-acting medications comprised 52.7% of prescriptions, with 99.0% of short-acting beta-agonists prescribed as metered-dose inhalers. Total estimated carbon emissions were 296.35 tonnes carbon dioxide equivalent, with metered-dose inhalers contributing 98.79% (292.8 tonnes). Short-acting beta-agonists alone accounted for 64.22% of total emissions. If all clinically appropriate metered-dose inhalers were switched to dry powder inhalers, emissions would decrease by 267.79 tonnes (90.36% reduction). More modest changes would yield substantial benefits: 85% conversion (227.62 tonnes reduction), 50% conversion (133.89 tonnes), and 10% conversion (26.78 tonnes).
Conclusions
This study addresses a critical knowledge gap by providing the first comprehensive analysis of hospital discharge inhaler prescriptions and their environmental impact in Australia. Metered-dose inhaler prescriptions at hospital discharge contribute disproportionately to healthcare carbon emissions, with the majority coming from short-acting medications. Substantial emission reductions are achievable through the preferential prescribing of dry powder inhalers where clinically appropriate. Hospital discharge represents a critical intervention point, as these prescriptions often template ongoing community prescribing. These findings provide essential baseline data for implementing Australia’s National Health and Climate Strategy and achieving significant healthcare emission reductions while maintaining quality care.
