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Carbon footprint impact of the choice of inhalers for asthma and COPD
  1. Christer Janson1,
  2. Richard Henderson2,
  3. Magnus Löfdahl3,
  4. Martin Hedberg4,
  5. Raj Sharma5,
  6. Alexander J K Wilkinson6
  1. 1 Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
  2. 2 Environment, Health, Safety and Sustainability, GlaxoSmithKline, Brentfor, London, UK
  3. 3 Worldwide Medical Affairs Europe Mid Size & Cluster R&D, GlaxoSmithKline, Solna, Stockholm, Sweden
  4. 4 Meteorologist, The Polyfuture Institute SWC AB, Nacka, Sweden
  5. 5 Respiratory Medical Franchise, GlaxoSmithKline, Brentford, London, UK
  6. 6 Respiratory Department, East and North Hertfordshire NHS Trust, Stevenage, UK
  1. Correspondence to Dr Christer Janson, Dep om Medical Sciences: Respiratory Medicine, Uppsala University, Uppsala 752 36, Sweden; christer.janson{at}


In the 1990s, metered dose inhalers (MDIs) containing chlorofluorocarbons were replaced with dry-powder inhalers (DPIs) and MDIs containing hydrofluorocarbons (HFCs). While HFCs are not ozone depleting, they are potent greenhouse gases. Annual carbon footprint (CO2e), per patient were 17 kg for Relvar-Ellipta/Ventolin-Accuhaler; and 439 kg for Seretide-Evohaler/Ventolin-Evohaler. In 2017, 70% of all inhalers sold in England were MDI, versus 13% in Sweden. Applying the Swedish DPI and MDI distribution to England would result in an annual reduction of 550 kt CO2e. The lower carbon footprint of DPIs should be considered alongside other factors when choosing inhalation devices.

  • asthma pharmacology
  • COPD pharmacology
  • inhaler devices

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  • Contributors The authors declare the following contributions to this study: AJKW, CJ, ML and RH developed the study concept; AJKW, CJ and RH were involved in the data analysis; all authors contributed to drafting and finalising the manuscript and approved the final version for submission; CJ is the guarantor, taking responsibility for work and/or conduct of study, full access to data, and control of decision to publish.

  • Funding Editorial support (in the form of collating author comments, assembling tables/figures, grammatical editing and referencing) was provided by Jenni Lawton, PhD, of Gardiner-Caldwell Communications (Macclesfield, UK), and was funded by GlaxoSmithKline.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare the following: CJ reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and TEVA outside the submitted work; MH reports honoraria from GlaxoSmithKline for presenting scientific data on climate change; AJKW has nothing to disclose; RH and RS are GlaxoSmithKline employees and hold GlaxoSmithKline stocks/shares, ML is an employee of GlaxoSmithKline.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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