A student pharmacy project aims to reduce greenhouse gas emissions by advocating for a simple change: having patients swap their metered dose inhalers with more environmentally friendly dry powder inhalers.
The project started as part of a BASE (behavioural, administrative, social and evidence-based pharmacy practice) course, one of the pharmacy curriculum's core courses. Community advocacy was the focus of the course's final term, and students were given a few potential organizations to work with on the project, explains PharmD student Sara Housh.
The Canadian Association of Pharmacy for the Environment (CAPhE) was one of the available organizations an easy choice for Housh, who had written a paper the previous year discussing the impact of pharmacy on the environment.
"I had an interest in the environment and how we can mitigate the impacts of pharmacy on the environment as pharmacists."
CAPhE identified inhalers as an area of health care where pharmacists could have a positive environmental impact, and the students got to work.
As Housh explains, metered dose inhalers better known as "puffers" are the more common form. They're prescribed often and are easy to use but they're not exactly environmentally friendly. "There are greenhouse gases inside the canister that get released with every dispense," she says.
A single metered dose inhaler can have the same carbon footprint as driving a car for 170 kilometres, and according to Housh, swapping to dry powder inhalers could reduce carbon dioxide emissions by around 455 kilograms per patient each year.
Dry powder inhalers contain a very finely milled powder rather than the pressurized aerosol in metered dose inhalers. While metered dose inhalers use the power of the pressurized canister to dispense the medication, dry powder inhalers require the patient to use their lung strength.
Though both types of inhalers are equally effective at treating conditions such as asthma and chronic obstructive pulmonary disease, dry powder inhalers may not be user-friendly for certain groups like young children or older adults. Since efficacy is always the number one consideration for pharmacists, Housh says, the recommendation only applies to those able to effectively dispense the medication.
"If someone doesn't have the tactile skills to use the dry powder inhaler, we wouldn't recommend it, with or without environmental considerations."
For the vast majority of patients, though, it's a simple swap with a big environmental impact.
To make the recommendation process as simple as possible for pharmacists, the student team prepared letter templates for switching from metered dose to dry powder inhalers. They have an option for Alberta pharmacists, who have prescribing authority, as well as a more suggestion-based alternative for pharmacists elsewhere in Canada that requires a doctor to pen the prescription.
They also created a flow chart to help pharmacists determine which inhaler would be the best option for patients based on their health considerations and conditions, as well as a series of patient education points to make conversations easier.
"Most people perhaps don't think of the long-term consequences of climate change on human health," says Housh. "With increasing climate change and changing weather, we're going to get longer dry periods. With that, there will be more cases of asthma and allergies, persisting beyond what we would normally see."
Another way to counter the negative environmental impact of inhalers is to reduce the reliance on rescue inhalers in particular. According to Housh, many patients with conditions requiring an inhaler will have some type of maintenance medication they take to manage their condition, as well as a rescue inhaler to use when something like intense aerobic activity triggers their condition. Rescue inhalers tend to be the metered dose format, explains Housh, so reducing the need for them can make a difference.
"If we can collectively reach those global targets for climate change mitigation, we can prevent more of those negative health impacts that are going to happen."
