TY - JOUR T1 - Environmentally friendly inhalers: issues for the general practice consultation JF - British Journal of General Practice JO - Br J Gen Pract SP - 484 LP - 485 DO - 10.3399/bjgp22X720821 VL - 72 IS - 723 AU - Joshua Parker Y1 - 2022/10/01 UR - http://bjgp.org/content/72/723/484.abstract N2 - Every day around the world we see the impacts of living with 1.2°C of global warming. It’s hard not to be concerned by the extreme weather events caused by anthropogenic climate change. Curbing emissions to avert further catastrophe is essential.The NHS recognised its role in global warming and became the first healthcare system on the planet to declare ambitions to become net zero for carbon emissions. In 2019, the NHS was responsible for around 7% of England’s total carbon footprint; approximately 25 million tonnes of CO2 equivalent.1 Medicines make up 25% of the NHS’ carbon footprint and are the biggest element of the carbon footprint of primary care.2Not all medicines are equal when it comes to global warming. Metered-dose inhalers (MDIs) have a disproportionate impact because they contain hydroflurocarbon propellants. These are powerful greenhouse gases. Take the propellant found in most inhalers, HFA134a. This is 1300 times more powerful than carbon dioxide.3 What this means is that if we put the same volume of carbon dioxide and HFA134a in the atmosphere and they stayed there for the same length of time, HFA134a traps 1300 times more heat than carbon dioxide.It’s easy to see how emptying a Ventolin Evohaler is like driving a mid-sized family car 175 miles.3 HFA134a isn’t even the worst hydroflurocarbon propellant — HFA227ea, found in Symbicort and Flutiform MDIs, is 3320 times more powerful than carbon dioxide.3 Unsurprisingly, the NHS has set targets to reduce the environmental impact of inhalers. As most inhaler prescriptions occur in primary care, this task falls to general practice.Broadly, there are … ER -