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It is well known that air pollution is a problem in many low and middle-income countries where AKHS works, but what is not known is the fact that some treatments for respiratory illness can contribute to climate change.In particular, pressurised Metered Dose Inhalers (pMDI) use gases to deliver medications which are potent greenhouse gases. The propellant gases used in pMDI are up to 3,350 times more potent than carbon dioxide as greenhouse gases. A single pMDI, if fully used, can release as much greenhouse gas emissions as a small car driven for 180 miles; a single patient may use more than 12 inhalers a year.

Fortunately, there are alternatives. Some propellant inhalers are better than others for delivering the same type of drug, either they use less propellant or a less damaging propellant. In most cases, dry powder-based inhalers can be just as clinically effective and have a small fraction of the environmental impact. For these reasons, dry powder inhalers are predominantly (90%) prescribed in Sweden.

AKHS is committed to reducing its own contributions to air pollution and the carbon impacts of respiratory care including:

  • Reducing the contribution of all its operations to air pollution (e.g. through smart choices of fuels used and incineration practices in health facilities);
  • Reviewing how inhalers are prescribed, dispensed, and used (oftentimes inhalers are not fully or properly used, reducing their health benefits and creating unnecessary waste);
  • Favouring lower carbon or propellant free inhaler alternatives where clinically appropriate;
  • Disposing of inhalers in environmentally safe way.

AKHS started examining the inhalers it was purchasing in 2019 along with an education programme to alert physicians and pharmacists to the relative impacts of different inhalers. In 2020, a system was established to track procurement and prescription practices with the aim to make changes and reductions wherever possible. AKHS intends to share information on the carbon footprint of pMDI and alternatives with health professionals in private and public sectors in the countries within which it works.

A range of estimated carbon impacts of several common inhalers can be seen below:




Global warming potential of propellant relative to CO2

Est. carbon footprint of propellant per device

Ventolin Evohaler




24kg (estimated @ 18.5g propellant

Salamol E-Breathe




10kg (estimated at 7.5g of propellant)


Fluticasone Propionate/ Formoterol Fumarate



37kg (estimated @ 11g of propellant)

Symbicort Turbohaler

Budesonide/Formoterol Fumarate