In the context of declaring a planetary emergency, many proponents are advocating for developing a greener world that can serve the dual purposes of reducing GHG (greenhouse gas) emissions and increasing their capture. Scientists, frequently encounter questions, inter alia, how more cities can adopt green roofs, how to develop more green fuels, and how to promote green agriculture? Of late, a new concept of 'greener medication' is emerging that promotes verified medical practices and encourages medical equipment, which delivers positive impacts for the environment. Initiatives are becoming established for employing practical and positive solutions, centred on a range of trusted and transparent market-based certifications, to inspire people to spend their money in ways that protect the climate.
The researchers at the University of Cambridge show that many people with asthma could cut their carbon footprint and help save the environment by switching to "greener medication." They illustrate making the swap would have as significant an "eco" impact as turning vegetarian or becoming an avid recycler. However, the patients must take advice from a doctor before changing medications.
Before adopting greener medications like using "greener inhalers" or environmentally-friendly inhalers, we need to explore a couple of questions such as what are greener inhalers, how much carbon do inhalers emit, what difference would it make, is it safe to switch, and what are the extra costs?
A greener inhaler means those inhalers are more environment-friendly such as dry-powder inhalers. Inhalers are a lifeline for people with lung disease. However, it is shocking that some inhalers come with a large carbon footprint. For instance, the most commonly used inhaler in the UK, namely, VentolinEvohaler™, has a carbon footprint equivalent to 28kg of CO2. Hence, we need to seek ways to reduce GHGs released from the inhalers. Researchers suggest that switching inhalers could save as much GHG as becoming vegetarian.
The Metered Dose Inhalers (MDIs) typically have a metal canister that you push down into a plastic case to release a puff of medicine into your lungs while you breathe in. Their main ingredient is a hydrofluorocarbon gas, which helps deliver the medicine into your lungs. Hydrofluorocarbons are potent GHGs - thousands of times more powerful than CO2.
MDIs can be bad for the environment, studies report. The climate change impacts of the MDIs are substantial-typically 20kg of CO2 per inhaler, but it can be more than twice this amount. 20 kg of CO2 is similar to driving about 125 miles in a Ford Fiesta.
Dry-powder inhalers (DPIs) are relatively more effective and more environmental-friendly; that is, the climate change impacts are small - typically equivalent to 1kg of CO2 per inhaler. However, many patients and particularly young children are unable to use dry powder inhalers, but some patients find powder inhalers more comfortable to use as they require less co-ordination than the MDIs.
The National Health Service (NHS) Sustainable Development Unit, UK, finds MDIs represent 3.5 per cent of the NHS's GHG emissions, and estimates about 70 per cent of inhalers dispensed in England are MDIs and just fewer than 30 per cent are DPIs. Replacing even one in every 10 of these inhalers with a more environmentally friendly type would reduce CO2 equivalent emissions by 58 kilotonnes, the researchers calculate. That is equivalent to the carbon footprint of 180,000 return car journeys from London to Edinburgh, they state.
At the individual level, each MDI replaced by a DPI could save the equivalent of between 150kg and 400kg of CO2 a year. A researcher reports "the gases within these canisters are such powerful GHGs that they can contribute significantly to an individual's carbon footprint and if you are using one or two of these inhalers (MDIs) every month, then that can really add up to hundreds of kilos of CO2 equivalent over the course of a year, which is similar to other actions that people are keen to take to reduce their carbon footprint such as going vegetarian."
DPIs are better than MDIs, and people should realise the fact and use MDIs, scientists say. Switching to a different type of inhaler, however, can be complicated for asthma patients, as it involves learning a new inhaler technique, so it should be done with support from practitioners. In that matter, the government or the respective department must provide information (for example, disseminating patient decision aids) to help people with asthma and their healthcare professionals should discuss their options for inhaler devices such as DPIs, soft mist inhalers, and breath-actuated metered-dose inhalers.
There are other measures to be greener. These include (a) use inhalers wisely by making sure every puff counts, (b) don't waste any by knowing how many doses their inhaler contains, and (c) dispose of inhalers properly so that they cannot emit further GHGs.
The costs are highly variable, depending on the type of inhalers, but typically between Tk1500 and TK40000 a per inhaler. Considering environmentally sustainable features of the DPIs, the government can intervene in making reasonable prices. The health authorities have repeatedly balked at the expense of greener inmhaler. The researchers argue we can cut costs by making prescription inhalers more environmentally friendly.
A consultant at Cambridge University states that switching to environment-friendly inhalers could help individuals, and the health sector as a whole, reduce their impact on the climate significantly. This initiative can be a vital step towards "greener medication" that creates a zero-carbon healthcare system fit for the 21st century.
Bangladesh should invest in greener medications as well as in the green pharmaceutical industry. The Directorate General of Drug Administration and Pharmacy Council of Bangladesh should take necessary actions to promote greener medications. They should put in place laws and regulations to determine, research, and scale-up environment-friendly medications technologies and innovations. More importantly, creating mass awareness and educating people about the climate problem can ultimately lead to growing a greener (medication) world.
Ranjan Roy, PhD is an Associate Professor in the Department of Agricultural Extension and Information System, Sher-e-Bangla Agricultural University
