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GOOD FOR YOU: Dr Andrew Dallas tells how the simple, life-saving asthma inhaler is harming the planet – and points to a greenhouse gas free alternative.


By Alasdair Fraser

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Woman with inhaler
Woman with inhaler

Today I want to tell you a little bit about medicine, climate science and inhalers – the “puffers” that are a vital lifeline for people with lung conditions like asthma.

You or someone close to you may well rely on these important medicines.

We have all had to learn so much this past year-and-a-half, with new words like lockdown, furlough and R-numbers.

The pandemic has accelerated the rate of change but, even prior to that, one constant has been that science is always moving on.

Working in any sphere of medicine we get used to the constant changes in evidence and best practice.

Sometimes change can be dizzying and, occasionally, frustrating.

The important thing to be clear on though is that in medical science, though evidence changes, the overall trajectory is towards better understanding, more accurate diagnoses and improved treatments.

The same is true of climate science.

It is a constantly evolving field and, to the average person on the street, it can feel confusing and disheartening.

But, like in medicine, I believe we must listen, we must learn and we must apply that learning for the good of all.

One such recent area of emerging evidence, where climate science and medicine converge is on the subject of inhalers.

It all centres around the propellant in Metered Dose Inhalers (MDIs) and it challenges the familiar norm of the way most UK doctors practice.

MDIs are the inhalers that you need to press in co-ordination with a deep breath in order to deliver the drug to the lungs (for many this will be a “blue puffer”).

In the UK, around 70 per cent of the inhalers we prescribe are of this type, whereas elsewhere Dry Powder Inhalers (DPIs) are the more common choice.

The problem is that the propellant in MDIs is thousands of times more potent as a greenhouse gas than CO2.

For example, one prescription of the most commonly used inhaler in the UK has emissions equivalent to a 174-mile journey in an average car.

The DPI equivalent has emissions equivalent to just a four-mile journey.

North of Scotland Royal College of General Practitioners Climate Champion, Dr Andrew Dallas of Cairn Medical Practice. Picture: Gary Anthony.
North of Scotland Royal College of General Practitioners Climate Champion, Dr Andrew Dallas of Cairn Medical Practice. Picture: Gary Anthony.

Clearly, inhalers can save lives, whereas car journeys generally do not.

However, when we consider the fact that for those in whom a DPI is appropriate, it will control their asthma at least as well as the MDI, the case for change is strong.

These differences become all the more important when we consider that poorer air quality and climate change will adversely affect those with respiratory problems.

This is just another example where we must listen to this evidence and implement change.

Within medicine, just as in wider society, it is imperative that we adapt.

So, if you are on an inhaler, perhaps you can look into this further at greeninhaler.org and raise it with your practice when you are next called in for an asthma review. If you are not on an inhaler, I would simply urge you to do your utmost to respect and respond to the emerging climate science so that together we can avert the worst of the health risks that will come with deteriorating climate breakdown.

• Dr Andrew Dallas is a GP partner at Cairn Medical Practice in Inverness and is also the north of Scotland Royal College of General Practitioners’ climate champion.

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