Key learning points

  • The UK government has set a target of ‘Net Zero’ for UK greenhouse gas emissions by 2050
  • Air pollution can contribute to a number of health problems including stroke, heart disease, lung cancer, and acute and chronic respiratory diseases
  • The NHS aims to reduce direct emissions to reach Net Zero by 2040 and reduce indirect emissions to reach Net Zero by 2045
  • Medicines account for 25% of the NHS emissions, including 3% produced by metered-dose inhalers (MDIs)
  • The NHS can reduce these emissions by encouraging the use of lower carbon inhalers, ensuring greener disposal of used inhalers and supporting innovation into lower carbon propellants*

*Inhalers are used in a variety of respiratory conditions, ranging from asthma to chronic obstructive pulmonary disease.

In 2019, the UK government announced a target of ‘Net Zero’ for UK greenhouse gas (GHG) emissions by 2050, following a report from the Climate Change Committee,1 and the 2015 Paris Climate Change Agreement.2

Net Zero means that the UK’s GHG emissions will be reduced so that total GHG emissions would be equal to or less than the GHG emissions removed from the atmosphere, for example by afforestation.1

Climate changes and impact on health

Air pollution can contribute to higher occurrence of stroke, heart disease, lung cancer, and acute and chronic respiratory diseases.3 

The World Health Organization has estimated that air pollution causes approximately 7 million deaths worldwide every year,3 and a report from the European Environment Agency in 2016 estimated that 467,000 deaths occur each year in Europe as a result of air pollution due to particulate matter.4

In the UK, not only could reaching the Net Zero target save more than 5,700 lives every year from improved air quality, but having a more physically active population could also save 38,000 lives, while eating healthier diets could save more than 100,000 lives.5

NHS Net Zero targets

The NHS is the largest employer in the UK and is responsible for approximately 4% of the UK’s carbon emissions, so it is paramount that the NHS is part of the climate change solution. The following targets were outlined in a recent NHS England report:5

  • For emissions created by the NHS directly (NHS Carbon Footprint), the aim is to reach Net Zero by 2040
  • For emissions that the NHS can influence (NHS Carbon Footprint Plus), the aim is to reach Net Zero by 2045

These targets will be met by addressing emissions in a number of areas including medicines and supply chains, transport and travel, and heating and lighting in hospitals.5

Direct and indirect emissions created by the NHS5

What does this mean for respiratory care?

Medicines account for about 25% of NHS emissions, and two medicine groups have been identified as significant contributors to this: anaesthetic gases (2% of emissions) and metered-dose inhalers (MDIs, 3% of emissions).5

Emissions from inhalers

MDIs contain hydrofluorocarbon propellants, which are used to deliver the medicine and contribute the majority of the 3% of emissions caused by inhalers. The NHS encourages the use of lower carbon inhalers, such as dry powder inhalers (DPIs), where clinically appropriate.5

The NHS has also pledged to develop a programme to encourage patients to return used inhalers to pharmacies to ensure greener disposal. Finally, the NHS has committed to supporting the pharmaceutical industry in research and development of lower carbon propellants.5

Low carbon inhalers

It is estimated that a 30% uptake of lower carbon inhalers would result in a reduction of 374 ktCO2e (kilotonnes of CO2 equivalent) per year.5 Moving from an MDI to a lower-carbon DPI requires informed decision making, involving the patient and healthcare professional to ensure that good quality asthma control is maintained. The NICE asthma patient decision aid6 has been developed to inform and help this transition. It is vital that patients are empowered to make this decision without compromising their care. Patient preference and adherence needs to be taken into consideration, as incorrect use of any inhaler could result in a hospital admission, negating any environmental benefit of changing inhaler type.

This educational site for healthcare professionals has been initiated and funded by Teva.