Green respiratory healthcare: need for proportionality

The Montreal Protocol on Substances That Deplete the Ozone Layer was an example of an amazing international collaboration that has already led to improvements in the ozone layer, although the full effects will not be seen for decades. As part of the process, large numbers of medical aerosols were reformulated such that chlorofluorocarbons were replaced as propellants in pressurised metered dose inhalers (pMDIs) by new hydrofluoroalkane (HFA) propellants. This involved a massive commitment by the pharmaceutical industry to ensure that those with respiratory ill health continued to receive their medication in familiar but improved inhalers. However, these HFA propellants have a global warming effect, and this has led specialist societies and health service leaders to more recently call for prescribers and patients to consider switching from pMDIs to inhaler devices without propellants, although many patients will still need a pMDI for use in an emergency.1 Others have recently additionally drawn attention to the benefits of using small-volume HFA 134a pMDIs or those containing …