Carbon footprint of pressurized gas metered dose inhalers (pMDI) in Brazil and Porto Alegre: impacts and alternatives

Abstract

Objective: To calculate the carbon footprint of pressurized gas-type metered-dose inhalers for asthma and chronic obstructive pulmonary disease control (COPD) dispensed by the brazilian national health service (SUS) in Brazil and in Porto Alegre (RS) in 2019. Method: Collection and analysis of data on the dispensation of salbutamol and beclomethasone by the SUS network and Farmácia Popular do Brasil in 2019, obtained by request to the Ministry of Health. Dispensations were multiplied by the proportional carbon footprint of each device using data already published in the literature. Results: In 2019, the prescription of pMDIs (pressurized metered-dose inhalers) within the Brazilian Unified Health System (SUS) resulted in the emission of approximately 24,889,141 to 60,878,728 metric tons of CO2 equivalent into the atmosphere across Brazil, which is equivalent to traveling by a typical gasoline-powered car from the northernmost to the southernmost point of the country between 23 to 57 million times. Furthermore, in the specific context of Porto Alegre, the emissions ranged from approximately 459,830 to 1,151,008 metric tons of CO2 equivalent, corresponding to traveling by a typical gasoline-powered car from the northernmost to the southernmost point of Brazil between 433,000 to 1 million times. Conclusion: The national health service in Brazil is responsible for emitting a massive amount of GHGs each year due to pMDI-type inhalation devices.  Switching to DPIs or SMIs in the indicated cases would avoid a great environmental damage, and at the same time would be of clinical benefit to patients, since they are the first choice currently recommended by the clinical guidelines for the treatment of asthma and COPD, promoting public health and, at the same time, planetary health.