How inhalers contribute in giving people the chance to breathe — or take it away

Life begins at first breath.

Energy Tracker Asia reports that in 2023, the Philippines had an average PM2.5 concentration of particles in the air of 13.5 micrograms per square meter. This makes the country the 79th in air pollution globally.

The World Health Organization (WHO) highlights that globally, 99 percent of the population breathe air that exceeds WHO guideline limits and contains high levels of pollutants, resulting in evident traces of air pollution. Being able to open a window and take a deep breath of clean, fresh air is slowly becoming a luxury, especially in middle to low-income countries. 

Researchers from the University of California and Harvard University have recently found that inhalers — the very thing helping individuals with respiratory issues to breathe significantly contribute to the global warming crisis.

According to WHO, air quality is closely linked to the Earth’s climate and ecosystems. Majority of sources of air pollution are also primary sources of greenhouse gas emissions.

Analyzing three different types of inhalers used to treat asthma and chronic obstructive pulmonary disease (COPD) between 2014 and 2024 from data from the national drug database in the United States (US), the researchers found that the accumulation of emissions to the environment had the same impact as driving 500,000 cars for an entire year.

Chronic respiratory diseases (CRDS) include asthma, COPDs, occupational lung diseases, and pulmonary hypertension. CRDS affects the lungs and airways, making it hard for individuals to breathe.

These diseases are not curable; however, their effects can be minimized and managed through medications such as inhalers, which provide fast-acting relief to individuals.

It was said that metered-dose inhalers, also known as “puffers,” accounted for 98 percent of emissions. This was because these canisters contained hydrofluoroalkane (HFA) propellants — potent greenhouse gases, making them pressurized to deliver medication.

Studies have shown that once exposed to the atmosphere, HFAs have a thousand times more potential of trapping heat in the atmosphere and global warming than carbon dioxide.

WHO reports that in 2017, 12 percent or approximately 11 million Filipinos were recorded to have asthma.

Common triggers of asthma and other CRDs include intense physical activity and inhaling dust, smoke, and air pollution.

“Five hundred and thirty thousand cars on the road each year is a lot, and I think this is a really important topic because it’s fixable – there are easy ways to reduce emissions,” William Feldman, lead author of the study and a pulmonologist and researcher at UCLA, said to news outlet AFP.

Other types of inhalers, including dry powder and soft mist inhalers, were seen to be a more “environmentally conscious” option than the metered-dose ones, as neither contains propellants. 

Dry powder inhalers solely rely on an individual’s breath to dispense the medication and account for 95 percent less carbon emissions, while soft mist inhalers turn the liquid medication into a fine spray.

Feldman notes that although only a small number of individuals with asthma rely on metered-dose inhalers, in the US, the majority of the demand for these types of inhalers comes from insurance and market barriers, as the greener options are much more expensive and are often not covered by insurance.

Common metered-dose inhalers of Salbutamol and Ventolin in the country cost at a range of Php 200 to Php 500. 

The researchers highlight that the study conducted aims not to put the blame on those who need these medications but to strengthen and urge policymakers to make other asthma treatments and greener alternatives more accessible.

“I think it’s incumbent upon us as a society to get those medications to the patients in a sustainable way, and that ultimately falls to the highest levels,” Feldman said.

In the ever-advancing world today, breathing must not become a privilege. Strengthening of health policies and accessibility without compromising the climate must be sought, as research further points out possible ways to mitigate the risks.

Inhalers may just be a portion of the things contributing to global warming. However, as change can be done, Feldman and his team see that it is better to create reforms in the healthcare system so that the very thing helping one to breathe does not further take away the air one so badly needs.