Rising Inhaler-Related Greenhouse Gas Emissions in the US
INHALERS prescribed for asthma and COPD generated nearly 25 million metric tons of greenhouse gas emissions in the United States over the past decade, according to a new serial cross-sectional analysis.
Assessing the Scale of Inhaler Emissions
Researchers analyzed aggregated national dispensing data for all inhalers approved for asthma or COPD between 2014 and 2024, estimating associated emissions using carbon dioxide equivalents (CO₂e). The study found that approximately 1.6 billion inhalers were dispensed nationwide, producing an estimated 24.9 million metric tons of CO₂e. Annual emissions rose 24%, from 1.9 million metric tons in 2014 to 2.3 million metric tons in 2024.
Metered-Dose Inhalers as Key Contributors
Metered-dose inhalers, which rely on hydrofluoroalkane propellants, accounted for 98% of total inhaler-related emissions. Most emissions originated from short-acting β-agonist, inhaled corticosteroid-long-acting β-agonist, and inhaled corticosteroid products. Three widely used agents, albuterol, budesonide-formoterol, and fluticasone propionate, contributed 87% of overall emissions. The total social cost of these greenhouse gases was estimated at $5.7 billion, with a range of $3.5–10.0 billion based on emission impact models.
Future Directions for Sustainable Respiratory Care
The analysis highlights a growing environmental footprint tied to inhaler use in the U.S., underscoring the need for lower-impact treatment options. Researchers suggested that policy interventions could help shift utilization toward dry powder and soft mist inhalers, which do not rely on propellant gases, while supporting development of affordable metered-dose alternatives with reduced global warming potential.
For clinicians, these findings reinforce that discussions about inhaler choice increasingly sit at the intersection of symptom control, patient preferences, cost and environmental impact. While patient safety and disease control remain the primary goals, awareness of inhaler-related greenhouse gas emissions may support more informed shared decision-making, especially when several clinically appropriate options are available. The authors suggest that targeted policies and innovation in device technology could help realign prescribing patterns over time, but practice change is likely to be gradual and context specific. Integrating environmental considerations into quality improvement initiatives and guideline discussions may help ensure that future respiratory care pathways remain both effective and sustainable.
Reference: Feldman WB et al. Inhaler-Related Greenhouse Gas Emissions in the US: A Serial Cross-Sectional Analysis. JAMA. 2025;334(18):1638-1649.
