First, do no harm while treating asthma
(Originally published by The Sudbury Star as “Sometimes the medicine we take adds to global warming” on Mar. 6, 2021)
The phrase “First, do no harm” is a guiding principle for health professionals and researchers. It’s part of the Hippocratic Oath still sworn by graduating medical students each spring. It warns us to be very sure we aren’t harming people in the course of trying to help them.
But what should we do when the emissions that cause climate change and air pollution are harming us, actually making us sick? When the health care system we’re part of, or rely on, is producing five percent of our nation’s greenhouse gas (GHG) emissions? Or when commonly used medicines like puffers (MDIs) are responsible for some three percent of that five percent? To put it simply, our health care is harming the planet and consequently our health.
It’s a circular issue. Many air pollutants are GHGs and contribute to global heating. Many GHGs are air pollutants, which affect our health. The garbage we unthinkingly dump into our atmosphere causes more children to develop asthma and pneumonia. It also makes breathing even harder for people with other lung conditions, like chronic bronchitis and emphysema.
People who struggle to breath are often treated with puffers. I’m referring to those small little pressure canisters that propel medicines into our lungs with the squeeze of the trigger and a big breath. Puffers come in a rainbow of colours, blue, orange, red, purple . . . some for quick action to open up the airways (like salbutamol, often called Ventolin), and others to prevent or manage attacks by reducing swelling and inflammation.
There’s no question the medicines in puffers are helpful. But MDIs are basically tiny aerosol cannisters filled with chemicals that propel the medicine out in a fine breathable mist. And those chemicals are extremely potent greenhouse gases. They escape into the atmosphere where they contribute to planetary heating, both when a puffer is used, and when it’s improperly disposed of, which is most of the time. And thus, in the course of helping with a medical condition, we do harm to the planet. And when we harm the planet, we harm ourselves.
Despite their global heating effects, MDIs have been allowed because way back in the 80s and 90s, they were deemed medically necessary. But these days, there are great alternatives available for many people with asthma and other chronic lung conditions: dry powder inhalers or DPIs. DPIs are also called Turbuhalers, Accuhalers, etc. They don’t require propellants. The medication is released and inhaled by taking a sharp, deep breath. DPIs aren’t suitable for everyone, but many teens and adults can use them effectively and get the breathing help they need without making the planet hotter.
So why do MDI puffers remain so popular? Research suggests that, for the most part, it’s not an issue of effectiveness. It’s more about the prescribing habits of doctors, the inhaling habits of patients, and some cavernous holes in our drug coverage.
You may well ask: is three percent of five percent of Canada’s emissions really worth fretting about? The answer is a resounding YES! We are up against a climate change wall. We need to curtail all our emissions, as a nation, and individually.
You’ve probably heard that driving less, flying less, and eating less meat are effective ways to reduce your personal carbon footprint. A study published in the journal Thorax last year found that for people who use two puffs from an MDI each day, switching to an equivalent DPI would have the same impact on their emissions as switching from meat-eating to a plant-based diet.
If DPIs offer the same benefits as MDIs, without causing harm to the planet’s climate and consequently our health, why wouldn’t we use them? If you’re a doctor or Nurse Practitioner, revisit your prescribing habits. If you’re an MDI user, talk to your physician about less harmful options you could try.
Elaine Blacklock M.D., F.R.C.P.(C)
Sources:
Janson C et al. Carbon Footprint impact of the choice of inhalers for asthma and COPD. Thorax 2020; 75:82-84.
British Thoracic Society: Position Statement on The Environment and Lung Health 2020. Available at https://www.brit-thoracic.org.uk/about-us/position-statements/
Joshi M et al. Climate change and respiratory diseases: a 2020 perspective. Current Opinion Vol. 26:2; pages 119-127. Abstract available on-line at https://journals.lww.com/co-pulmonarymedicine/Abstract/2020/03000/Climate_change_and_respiratory_diseases__a_2020.4.aspx
Beauchesne M et al. Global initiative for Asthma report: How will new recommendations affect practice in Canada? CMAJ April 27, 2020. Available on-line at: https://www.cmaj.ca/content/192/17/E456
Wintemute K and Miller F. Dry powder inhalers are environmentally preferable to metered-dose inhalers. CMAJ July 20, 2020. Available on-line at https://www.cmaj.ca/content/192/29/E846