Care for a cleaner world – Why aiming for carbon neutral care matters, and what it means for asthma and COPD

Nearly 300 million people are affected by asthma worldwide, and more than 300 million by chronic obstructive pulmonary disease (COPD), with the numbers projected to increase in the future.^1,2 Inhaled therapy is the most common form of treatment due to its effectiveness. However, there is an increasing need to minimise the environmental impact of care across healthcare services, including national health organisations, device producers and the pharmaceutical industry. The detrimental impact of health care on environment and climate can be mitigated through minimising greenhouse gas (GHG) emissions and offsetting - creating carbon neutral care options also for asthma and COPD.²

Climate change, loss of biodiversity and overconsumption are different sides to the same sustainability crisis that threatens the harmony of the planet’s ecosystems. Primarily attributed to an excess of carbon and other greenhouse gas emissions, this imbalance creates a greenhouse effect, which is rapidly heating up the Earth’s atmosphere and altering ecosystems with unprecedented outcomes. In fact, many studies link planetary health to human health, showing that climate change and biodiversity loss are enormous health threats and can lead to, for instance, emergence of novel infections. Health effects often impact vulnerable groups disproportionately.³

To mitigate climate change, reducing human-induced global greenhouse gas emissions is essential. In fact, the United Nations has described the quest to become carbon neutral as “the world’s most urgent mission”.⁴ This is a mission that the pharmaceutical industry too must take into account, while providing care to promote human health. It is for this reason that many pharmaceutical companies have announced plans to reach net zero climate emissions – carbon neutrality – in the coming decades.⁵

What is carbon neutrality exactly?

What does carbon neutrality mean and how is it achieved? In short, carbon neutrality means reducing the carbon footprint of any activity to net zero through a combination of in-house efficiency measures, switching to renewable energy, and encouraging external emission reductions in the supply chain.⁶

For a single pharmaceutical product to become carbon neutral, for instance, the company must first minimise the direct and indirect greenhouse gas emissions across all the activities within the product’s lifecycle. Secondly, the remaining emissions, which cannot be eliminated, need to be offset by projects that remove the same amount of greenhouse gases that is emitted into the atmosphere.⁶

Similarly, for a company to reach carbon neutrality, it needs to first calculate its own climate emissions, then reduce them where possible, and offset the rest. There are also different levels to carbon neutrality: beyond a company’s own operations, major emissions are usually produced in its supply chain and through its products. Usually, a company’s journey toward carbon neutrality may start from its own operations or selected products and then span out to include more of the supply chain, products and employees’ emissions.⁶

Reducing the climate impacts of asthma and COPD treatment

Inhalers are the mainstay treatment for asthma and COPD. Through inhaler design, medicine is targeted to the airways where they work effectively with minimum side-effects. With asthma and COPD affecting hundreds of millions of people across the globe, and the prevalence of respiratory diseases projected to increase globally, reducing the emissions of inhalers can have a significant effect on diminishing climate impacts.⁷ In fact, there has been a consistent effort in the pharmaceutical industry to reduce the climate effects of inhaled therapy, already starting in the 1980s. One milestone was the decision to ban ozone-depleting chlorofluorocarbon propellants (CFCs) in inhaled products by the Montreal Protocol in 1987.²

However, the most commonly used inhalers, pressurised metered dose inhalers (pMDIs), still use potent greenhouse gases called hydrofluoroalkane, which contain HFCs, to push the medicine out of the inhaler. Just five doses from an pMDI have a global warming potential equivalent to a nine-mile car trip, with each dose having an estimated carbon footprint of up to 500g of carbon dioxide, and emitting up to 36kg of CO2 in its lifetime.⁸

The introduction of propellant-free inhaler models in the 1990s was a leap forward for climate-friendly care. Dry powder inhalers (DPIs) deliver powdered medication where the active ingredient is expressed without the need for a propellant. Because propellants contain HFCs, potent greenhouse gases, preferring DPIs can diminish climate impacts significantly. In fact, each dry powder inhaler’s lifecycle emissions are 10 to 37 times lower compared to pMDIs.⁹

Changes to treatment should only be done following collaboration between patients and their doctor. In 2019, The National Institute for Health and Clinical Excellence (NICE) in the UK, issued guidance in the form of a patient decision aid for people who require and inhaler to help factilitate these conversations. This decision aid is designed to support patients and healthcare professionals to identify potential inhalers that could not only meet the needs of that patient but also help lower the health services carbon footprint.¹⁰

Carbon neutral care is the future

In addition to providing care options that are by design more climate-friendly, pharmaceutical companies are now also taking other actions to reach full carbon neutrality in asthma and COPD care. Many companies have assessed the carbon footprint of asthma and COPD products and published them in medical journals. These are used as the basis for creating a journey toward net zero carbon emissions, together with a verified partner specialised in carbon neutrality programmes. 

In practice the journey means minimising the carbon footprint of the asthma or COPD product – an inhaler, for instance – across its entire lifespan from sourcing of the raw materials to manufacturing, distribution and end-of-life disposal. Methods to reduce emissions may include, for instance, using renewable energy in production facilities, and reducing scrapping by cooperating with suppliers to choose the best, most sustainable materials. Focus can also be put in environmental packaging materials and transportation methods.

After the company has minimised emissions wherever possible, the remaining emissions can be offset through projects that reduce greenhouse gas emissions elsewhere. These projects can include, for instance, reforestation and forest protection programmes, as forests act as natural carbon sinks removing CO₂ from the atmosphere through photosynthesis. After it has been verified by a third party that the product’s remaining carbon footprint is offset through carbon reduction schemes, the product can be said to be carbon neutral.

Carbon neutral care requires a consistent effort by the pharma industry, as well as subcontractors, regulators and healthcare professionals.  To build a path towards a greener future all stakeholders need to collaborate closely to ensure effective and safe health care, while making the necessary changes to secure a healthy environment and clean air for all of us to breath for generations to come.

Date of preparation: June 2021 / EASYH-1515

Reference

1. Turner, R. M., DePietro, M., & Ding, B. (2018). Overlap of Asthma and Chronic Obstructive Pulmonary Disease in Patients in the United States: Analysis of Prevalence, Features, and Subtypes. JMIR public health and surveillance, 4(3), e60. https://doi.org/10.2196/publichealth.9930
2. United Nations Environment Programme. 2018. Medical and Chemicals Technical Options Committee. 2018 Assessment Report. Accessed 6th May 2021 from: https://ozone.unep.org/sites/default/files/2019-04/MCTOC-Assessment-Report-2018.pdf
3. Schmeller, D.S., Courchamp, F. & Killeen, G. Biodiversity loss, emerging pathogens and human health risks. Biodivers Conserv 29, 3095–3102 (2020). https://doi.org/10.1007/s10531-020-02021-6
4. United Nations. 2020. Carbon Neutrality by 2050: theWorld’s Most Urgent Mission accessed on 6th May 2021 from: https://www.un.org/sg/en/content/sg/articles/2020-12-11/carbon-neutrality-2050-theworld’s-most-urgent-mission
5. Hargreaves, B., 2020. AZ and Takeda outline sustainability plans. Outsourcingpharma.com. Accessed on 6th May 2021 from: https://www.outsourcing-pharma.com/Article/2020/01/30/Major-pharma-companies-launch-sustainability-push
6. Wollerton, M., 2021. What does carbon neutral mean?. Cnet. Accessed on 6th May 2021 from: https://www.cnet.com/home/energy-and-utilities/what-does-carbon-neutral-mean/
7. Kluger, J., 2019. How One Commonly Used Asthma Inhaler is Damaging the Planet. TIME. Accessed on 6th May 2021 from: https://time.com/5717676/asthma-inhalers-and-climate/
8. The Pharmaceutical Journal, PJ, June 2019, Vol 302, No 7926;302(7926):DOI:10.1211/PJ.2019.20206606. Accessed on 6th May 2021 from: https://pharmaceutical-journal.com/article/letters/reducing-the-impact-of-asthma-treatment-on-climate-change#fn_2
9. Wilkinson AJK, Braggins R, Steinbach I, et al. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open 2019;9:e028763. doi:10.1136/bmjopen-2018-028763.
10. NICE., 2019. NICE encourages use of greener asthma inhalers. Accessed on 6th May 2021 from: https://www.nice.org.uk/news/article/nice-encourages-use-of-greener-asthma-inhalers

Orion Corporation is a globally operating Finnish pharmaceutical company. We develop, manufacture and market human and veterinary pharmaceuticals and active pharmaceutical ingredients. The dry powder inhaler developed at Orion is in the core of our respiratory therapy area.