The UK government declared a “climate emergency” on May 1st 2019

Do you think about your inhaler's carbon impact?

When trying to reduce your carbon footprint don't forget the role your inhaler plays.

What can you do?


  • Use the NICE decision aid1 to make an inhaler choice with your doctor or nurse
  • This guide includes considerations such as ease of use, technique and carbon footprint of all inhalers

  • MDIs and DPIs require different inhalation techniques – please check with your doctor or nurse that you are inhaling your medication correctly

  • Responsible disposal of inhalers is also an important step towards reducing carbon emissions from inhalers2

Use this decision aid* with your doctor or nurse to choose the right inhaler for you1

Download inhaler decision aid1

Download inhaler decision aid user guides3

*This decision aid was created by NICE (National Institute for Health and Care Excellence) and published in April 2019


The impact different inhalers have on the environment

An inhaler that uses a propellant to drive the drug into the patients' lungs usually has a higher carbon footprint than those that don't2.

They usually have a similar shape. They are often referred to as 'spray' inhaler, puffer or MDI (metered dose inhaler).


An inhaler that does not require a propellant usually has a lower carbon footprint than those that do. The medicine is drawn into the lungs by the patient’s respiratory effort (breathing in)2

There are many different shapes and types of low carbon inhalers, collectively known as DPIs (dry power inhalers).



100 doses of a pressurised Metered Dose Inhaler (pMDI) have a carbon footprint roughly equal to a 180-mile drive? 8,9,10,11

A high carbon MDI inhaler has a carbon footprint that is 18x higher than a low carbon DPI inhaler4

Inhaler Environmental Impact Comparison

(798k tonnes)
of the NHS total carbon emissions are from MDI inhalers5

MDI Carbon Emissions
  • MDIs contain hydroflurocarbons2
  • Hydroflurocarbons are in the propellant in MDIs2
  • Hydroflurocarbons are greenhouse gases that have a global warming effect of 3,800 times that of CO24
  • Therefore, these inhalers have a far higher carbon footprint than those that don't contain propellant, such as DPIs.

of all inhalers dispensed in the UK are
high carbon inhalers5.

MDI 70%

Although MDIs are less harmful to the environment than they used to be, some healthcare professionals may be unaware of their environmental impact.

The UK prescribes proportionately far more MDIs than European countries. Only 10% of inhalers dispensed in Sweden are high carbon MDI inhalers4.

MDIs/sprays may still be the appropriate option for some patients. Please consult your doctor, nurse or pharmacist to discuss which inhaler is best for you.

Support the NHS

Not only does this help reduce your carbon emissions but also helps the NHS' goals to reduce carbon emissions by 34% by 20206

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  1. National Institute for Healthcare and Excellence: asthma patient decision aid.
  2. Labiris and Dolovic (2003) Pulmonary drug delivery. British Journal of Clinical Pharmacology. DOI:10.1046/j.1365-2125.2003.01893.x
  3. National Institute for Healthcare and Excellence: asthma patient decision aid user guide:
  4. Hillman, T. Mortimer, F and Hopkinson, N. (2013). Inhaled drugs and global warming: time to shift to dry powder inhalers. British Medical Journal. DOI: 10.1136/bmj.f3359.
  5. EAC Report – Progress on reducing F-gases:
  1. NHS Long Term Plan:
  2. British Lung Foundation (2019). Which inhalers are kindest to the environment.
  3. NICE (2019). National Institute for Healthcare and Excellence: asthma patient decision aid user guide
  4. 2014 Report of the United Nations Environment Programme Medical Technical Options Committee
  5. 2017 National Travel Survey, UK Department for Transport
  6. Greenhouse gas reporting conversion factors 2018,