From Wildfires to Inhalers: The Hidden Environmental Cost of Respiratory Care and How Tech May Help
The Breathing Crisis: A Global Concern
For millions, climate change is a silent threat to their respiratory health. From asthma attacks triggered by pollution to lung damage from wildfire smoke, the very air we breathe is becoming increasingly hazardous. Simultaneously, the healthcare systems tasked with treating these conditions are contributing to the very problem they aim to solve, as they themselves generate significant greenhouse gas emissions.
A Rising Tide of Respiratory Illness
Climate extremes and poor air quality are driving a surge in respiratory diseases. Air pollution, heatwaves, wildfires, and extended pollen seasons are all contributing factors. Over 90% of the global population breathes air with particulate matter exceeding the World Health Organization's recommendations, highlighting the pervasive nature of this issue.
Environmental Factors at Play
Experts emphasize that a significant portion of respiratory illnesses is linked to environmental factors. Increasing wildfires and air pollution are altering the air we breathe, heightening the risks of exacerbations, disease progression, and, in some cases, the onset of disease.
Climate Change: A Trigger for Asthma and Chronic Diseases
Therese Laperre, head of the respiratory department at the University Hospital Antwerp, warns that climate change intensifies triggers for asthma and chronic respiratory diseases, as well as patterns of respiratory infections. Changes in particulate matter have a lasting impact on emergency department visits for patients with asthma and chronic pulmonary disease.
The European Perspective
A study by the European Environment Agency reveals a startling statistic: over one-third of all chronic respiratory disease deaths in Europe are linked to environmental factors such as air pollution, extreme temperatures, wildfire smoke, and allergenic pollen.
A Vicious Cycle: Healthcare's Climate Cost
Globally, an estimated 400-500 million adults suffer from COPD, and over 250 million people live with asthma. The healthcare response to this burden has its own climate cost. Health Care Without Harm estimates that global health services generate about 5% of worldwide greenhouse gas emissions, ranking among the world's top polluters if they were a country.
Without intervention, healthcare emissions are projected to reach 6 gigatons annually by 2050, equivalent to adding more than a billion cars to the road.
Hospitals: Major Polluters
Hospitals, especially intensive care units (ICUs), are significant contributors to this impact. They are among the most polluting parts of the healthcare system per patient due to high energy consumption, equipment use, and single-use materials.
Early Intervention: A Climate Measure
Respiratory specialists emphasize that early control of chronic diseases by healthcare professionals is not only beneficial for patients but also crucial for reducing the healthcare sector's climate footprint.
Philippe Tieghem, from the French respiratory association Sante Respiratoire, highlights the dual benefits of early diagnosis: "If we detect earlier, we control earlier, it's good for patients, good for carbon, and economically advantageous."
Inhalers: A Dilemma Embodied
One product exemplifying this dilemma is the inhaler, primarily used to treat long-term lung diseases like COPD and asthma.
The most common inhalers are pressurized metered-dose (pMDI) devices, which use gas to propel medication directly into the lungs. These inhalers often contain hydrofluorocarbons (HFCs), potent greenhouse gases with high global warming potential.
The Environmental Impact of Inhalers
Recent estimates indicate that pressurized inhalers emit approximately 4-5 million tonnes of CO₂-equivalent annually in Europe and around 16-17 million tonnes globally, accounting for 0.03% of total greenhouse gas emissions. The UK's National Health Service estimates that these inhalers contribute to about 3% of its carbon footprint.
Decarbonization Efforts
Despite the relatively small portion of global emissions, the numbers are substantial enough for health services and manufacturers to prioritize inhaler decarbonization. Traditional inhalers are being engineered to use "greener" gases.
A Step Towards Change
AstraZeneca's reformulated COPD inhaler, approved for use in the UK and EU, is a notable example. It contains the same active medicines as its predecessor but uses a new propellant, HFO-1234ze(E), significantly reducing its warming impact by 99.9% compared to the old gas.
Emission Reduction Commitments
AstraZeneca has pledged to cut its emissions by 98% by 2026, focusing on inhalers and scope 3 emissions linked to suppliers and product use. Pablo Panella, senior vice-president for respiratory diseases, emphasizes the importance of early detection, diagnosis, and treatment to reduce hospital capacity and costs.
Industry-Wide Initiatives
Other major drugmakers are also committing to emission reduction and environmental footprint reduction. Pfizer has set a company-wide climate plan to reach net-zero by 2040, while Johnson & Johnson aims for the same goal by 2045.
The Green Patient
Better control of chronic diseases translates to fewer emergency admissions and reduced reliance on resource-intensive care, a concept known as the "green patient."
Regulatory Role
Panella emphasizes that regulation plays a pivotal role in supporting innovation, especially in addressing environmental footprints. He advocates for welcoming and facilitating regulations, as complex and cumbersome rules can delay patient access to new technologies.
Conclusion: A Call for Action
The healthcare industry's journey towards decarbonization is complex, requiring collaboration between technology, regulation, and patient care. By addressing the environmental impact of respiratory care, we can take a significant step towards a healthier, more sustainable future for all.
