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Reducing hospital pharmacies’ carbon emissions by distributing fewer metered dose Inhalers

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European Statement

Selection, Procurement and Distribution

Author(s)

Anna Harjans, Dominic Störzinger, Torsten Hoppe-Tichy

Why was it done?

Nowadays, norflurane is often used as MDIs’ propellant. It has a Global Warming Potential (GWP) 1,430 times higher than CO2. Therefore, MDIs cause larger emissions than DPIs. By lowering the numbers of MDIs in-house prescriptions, savings of emissions can be achieved.

What was done?

All Metered Dose Inhalers (MDI) of our formulary were screened for the following criteria:
– Which Active Pharmaceutical Ingredient(s) (API) are contained?
– Are comparable Direct Powder Inhalers (DPI) available?
– Can MDIs be replaced by a DPI considering wards and patients’ needs?
Distribution numbers one year before/after formulary adaptation were analysed. Furthermore, subsequent savings of greenhouse gas emissions have been calculated.
Note: Different devices cause different Carbon dioxide equivalent (CO2e) emissions because of their individual product life cycle, means that CO2e-calculations are depending on the manufacturer. Thus, it is imperative to name the exact devices in this analysis.

How was it done?

Availability of comparable DPIs with the same (combination of) API(s) and dosage for each MDI was assessed for the German market. Wards with highest orders of MDIs were identified to see who may be affected by a device change. Physicians in charge were contacted to replace MDIs where possible. Subsequently the formulary was adapted.
Saved emissions were calculated on the basis of current literature [Foster® 100/6 µg: 94.42 g CO2e/puff, Foster® NEXThaler® 100/6 µg: 7.63 g CO2e/puff (Pangione, S., et al. (2020))].

What has been achieved?

One MDI (Foster® 100/6 µg) was replaced in the formulary by an equivalent DPI (Foster® NEXThaler® 100/6 µg). Distribution numbers are shown below:

– Foster® 100/6 µg: 272 (one year pre adaptation), 4 (one year post adaptation)
– Foster® NEXThaler® 100/6 µg: 150 (one year post adaptation)

By means of this our hospital pharmacy reduced emissions by 2.921,9 kg CO2e compared to preadaptation.

What next?

MDIs containing new propellants with lower GWP are already being worked on by the pharmaceutical industry and thus, more climate friendly opposed to conventional MDIs. Replacing current MDIs with the novel, climate friendly alternatives once available on the market is a useful approach to further lower hospital pharmacies’ carbon emissions.

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