EU Legislation in Progress. Review of the regulation on fluorinated greenhouse gases. https://www.europarl.europa.eu/RegData/etudes/BRIE/2022/733673/EPRS_BRI(2022)733673_EN.pdf (2022).

National Health Service. Delivering a ‘net zero’ National Health Service. https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf (2020).

Shah, R., Hagell, A. & Cheung, R. International comparisons of health and wellbeing in adolescence and early adulthood. Research report, Nuffield Trust and Association for Young People’s Health. https://www.nuffieldtrust.org.uk/research/international-comparisons-of-health-and-wellbeing-in-adolescence-and-early-adulthood (2019).

Wolfe, I. et al. Health services for children in western Europe. Lancet 381, 1224–1234 (2013).

Article  PubMed  Google Scholar 

National Review of Asthma Deaths. Why asthma still kills. https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills (2014).

Attar-Zadeh, D., Lewis, H. & Orlovic, M. Health-care resource requirements and potential financial consequences of an environmentally driven switch in respiratory inhaler use in England. J. Health Econ. Outcomes Res. 8, 46–54 (2021).

Article  PubMed  PubMed Central  Google Scholar 

Usmani, O. S. et al. Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes. Respir. Res. 19, 10 (2018).

Article  PubMed  PubMed Central  Google Scholar 

Bjornsdottir, U. S., Gizurarson, S. & Sabale, U. Potential negative consequences of non-consented switch of inhaled medications and devices in asthma patients. Int J. Clin. Pr. 67, 904–910 (2013).

Article  CAS  Google Scholar 

Plaza, V. et al. Impact of patient satisfaction with his or her inhaler on adherence and asthma control. Allergy Asthma Proc. 39, 437–444 (2018).

Article  PubMed  PubMed Central  Google Scholar 

Matthews, S. Asthma inhalers emit as much carbon as a 180-mile car journey, says Government health watchdog as it urges patients to use more environmentally-friendly devices. Daily Mail. (2019). https://www.dailymail.co.uk/health/article-6899525/Asthma-patients-urged-consider-environmentally-friendly-inhalers.html (2022).

Righton, L. Six inhaler sustainability myths—and why they must be busted. ONdrugDelivery 126, 30–34 (2021).

Google Scholar 

Jeswani, H. K. & Azapagic, A. Life cycle environmental impacts of inhalers. J. Clean. Prod. 237, 117733 (2019).

Article  CAS  Google Scholar 

Usmani, O. S., Scullion, J. & Keeley, D. Our planet or our patients—is the sky the limit for inhaler choice? Lancet Respir. Med. 7, 11–13 (2019).

Article  PubMed  Google Scholar 

Pritchard, J. N. The climate is changing for metered-dose inhalers and action is needed. Drug Des. Dev. Ther. 14, 3043–3055 (2020).

Article  Google Scholar 

Usmani, O. S. Choosing the right inhaler for your asthma or COPD patient. Ther. Clin. Risk Manag. 15, 461–472 (2019).

Article  PubMed  PubMed Central  Google Scholar 

Lavorini, F. et al. Retail sales of inhalation devices in European countries: so much for a global policy. Respir. Med. 105, 1099–1103 (2011).

Article  CAS  PubMed  Google Scholar 

Janson, C. et al. Carbon footprint impact of the choice of inhalers for asthma and COPD. Thorax 75, 82–84 (2020).

Article  PubMed  Google Scholar 

Nwaru, B. I. et al. Overuse of short-acting beta(2)-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur. Respir. J. 55, 1901872 (2020).

Article  CAS  PubMed  PubMed Central  Google Scholar 

GlaxoSmithKline. Complete the cycle. http://uk.gsk.com/en-gb/responsibility/ourplanet/complete-the-cycle/ (2014).

Wilkinson, A. J. K., Braggins, R., Steinbach, I. & Smith, J. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open 9, e028763 (2019).

Article  PubMed  PubMed Central  Google Scholar 

Levy, M. L. Inhaler devices and global warming: Flawed arguments. BMJ Open 9, https://bmjopen.bmj.com/content/9/10/e028763.responses (2019).

Wilkinson, A. et al. Greenhouse gas emissions associated with asthma care in the UK: results from SABINA CARBON. Eur. Respir. J. 58, OA76 (2021).

Google Scholar 

Suissa, S. & Ernst, P. Inhaled corticosteroids: impact on asthma morbidity and mortality. J. Allergy Clin. Immunol. 107, 937–944 (2001).

Article  CAS  PubMed  Google Scholar 

Suissa, S., Ernst, P., Benayoun, S., Baltzan, M. & Cai, B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N. Engl. J. Med. 343, 332–336 (2000).

Article  CAS  PubMed  Google Scholar 

Suissa, S. et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am. J. Respir. Crit. Care Med. 149, 604–610 (1994).

Article  CAS  PubMed  Google Scholar 

Suissa, S., Ernst, P. & Kezouh, A. Regular use of inhaled corticosteroids and the long term prevention of hospitalisation for asthma. Thorax 57, 880–884 (2002).

Article  CAS  PubMed  PubMed Central  Google Scholar 

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. https://ginasthma.org/wp-content/uploads/2022/05/GINA-Main-Report-2022-FINAL-22-05-03-WMS.pdf (2022).

Cabrera, C. S. et al. SABINA: global programme to evaluate prescriptions and clinical outcomes related to short-acting beta2-agonist use in asthma. Eur. Respir. J. 55, 1901858 (2020).

Article  PubMed  Google Scholar 

Scullion, J. Sustainability 3: how nurses can reduce the environmental impact of inhalers. Nursing Times [online] 116, 38–40 (2020).

Google Scholar 

Keeley, D., Scullion, J. E. & Usmani, O. S. Minimising the environmental impact of inhaled therapies: problems with policy on low carbon inhalers. Eur. Respir. J. 55, 2000048 (2020).

Article  PubMed  Google Scholar 

Pernigotti, D. et al. Reducing carbon footprint of inhalers: analysis of climate and clinical implications of different scenarios in five European countries. BMJ Open Respir. Res. 8, e001071 (2021).

Article  PubMed  PubMed Central  Google Scholar 

National Health Service. Network Contract Directed Enhanced Service. Investment and Impact Fund 2022/23: Updated Guidance. March (2022).

Rogueda, P. & Traini, D. The future of inhalers: how can we improve drug delivery in asthma and COPD? Expert Rev. Respir. Med. 10, 1041–1044 (2016).

Article  CAS  PubMed  Google Scholar 

Sanchez-Nieto, J. M. et al. Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma. NPJ Prim. Care Respir. Med 32, 1 (2022).

Article  PubMed  PubMed Central  Google Scholar 

Usmani, O. S. et al. Real world impact of non clinical inhaler switching on asthma or COPD patients—a systematic review. In: American Thoracic Society International (Virtual Congress, 2022).

Bell, J., Ding, B., De Nigris, E. & Haughney, J. Greenhouse gas emissions associated with COPD care in the UK: Results from SHERLOCK CARBON. Eur. Respir. J. 58, PA3551 (2021).

Google Scholar 

Tennison, I. et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health 5, e84–e92 (2021).

Article  PubMed  PubMed Central  Google Scholar 

Robinson, J. NHS England has no plans for a national inhaler recycling scheme despite net zero ambitions. Pharm. J. 307 (2021).

Murphy, A., Howlett, D., Gowson, A. & Lewis, H. Understanding the feasibility and environmental effectiveness of a pilot postal inhaler recovery and recycling scheme. NPJ Prim. Care Respir. Med 33, 5 (2023).

Article  PubMed  PubMed Central  Google Scholar 

DeWeerdt, S. The environmental concerns driving another inhaler makeover. Nature 581, S14–S17 (2020).

Article  CAS  Google Scholar 

Bonini, M. & Usmani, O. S. Novel methods for device and adherence monitoring in asthma. Curr. Opin. Pulm. Med 24, 63–69 (2018).

Article  PubMed  Google Scholar 

Asthma and Lung UK. Cleaning and looking after your inhaler. https://www.asthma.org.uk/advice/inhalers-medicines-treatments/inhalers-and-spacers/cleaning-and-looking-after-your-inhaler (2022).

British Thoracic Society. Position statement: the environment and lung health 2020. https://www.brit-thoracic.org.uk/document-library/governance-and-policy-documents/position-statements/environment-and-lung-health-position-statement-2020/#:~:text=Our%20objectives%20are%20to%20develop,about%20prevention%20of%20respiratory%20diseases. (2019).

Haughney, J. et al. Choosing inhaler devices for people with asthma: current knowledge and outstanding research needs. Respir. Med. 104, 1237–1245 (2010).

Article  PubMed  Google Scholar 

Newman, S. P. Inhaler treatment options in COPD. Eur. Resp. Rev. 14, 102–108 (2005).

Article  Google Scholar 

Roche, N. & Dekhuijzen, P. N. The evolution of pressurized metered-dose inhalers from early to modern devices. J. Aerosol Med. Pulm. Drug Deliv. 29, 311–327 (2016).

Article  CAS  PubMed  Google Scholar 

Sellers, W. F. S. Asthma pressurised metered dose inhaler performance: propellant effect studies in delivery systems. Allergy Asthma Clin. Immunol. 13, 30 (2017).

Article  PubMed  PubMed Central  Google Scholar