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Inhalers that deliver quick relief to patients with asthma and chronic obstructive pulmonary disease (COPD) may be taking a toll on the planet, producing as much climate-warming pollution as more than half a million cars each year.
Researchers reported in a new JAMA study that inhalers have generated more than 2 million metric tons of carbon emissions each year over the last decade, equivalent to the emissions of about 530,000 gas-powered cars on the road annually.
The study analyzed emissions from the three different types of inhalers approved for asthma or COPD from 2014 to 2024, finding metered-dose inhalers were the most damaging to the environment.
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Researchers alleged metered-dose inhalers, which use hydrofluoroalkane (HFA) propellants—potent greenhouse gases used in aerosol sprays, were responsible for 98 percent of emissions over the decade.
Other inhalers, like dry powder and soft mist inhalers, deliver medication without propellants and have a much smaller environmental footprint.
Certain companies, like AstraZeneca, have already committed to transitioning from pressurized metered-dose inhalers (pMDIs) to propellants with substantially less global waring potential.
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The study’s lead author, Dr. William Feldman, a pulmonologist and health services researcher at the David Geffen School of Medicine at UCLA, said inhalers put patients with chronic respiratory disease at risk.
“On the upside, there is tremendous opportunity to make changes that protect both patients and the planet by utilizing lower-emission alternatives,” Feldman wrote in a UCLA news release.
To conduct the analysis, researchers drew from a comprehensive national database of inhaler prescriptions, at the National Drug Code (NDC) level.
Emissions were then estimated using validated academic studies and analyzed by drug type, device type, propellant type, therapeutic class, branded status, manufacturer, payer and pharmacy benefit manager.
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The team plans to expand the research to evaluate inhaler emissions in specific patient groups, such as Medicaid recipients, and to compare clinical outcomes of low and high-emission inhalers in the same therapeutic class.
They will also investigate how pricing and patent strategies could shape the rollout of new, lower-emission inhaler technologies.
“A key first step to driving change is understanding the true scale of the problem,” Feldman said. “From there, we can identify what’s fueling these emissions and develop targeted strategies to reduce them—benefiting both patients and the environment.”
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