More environmentally friendly inhalers

So you’ve read that metered-dose (spray) inhalers contain powerful greenhouse gases, and you want to know what other options there are. For many patients, effective and more environmentally-friendly alternatives to metered dose inhalers are available; mainly as dry-powder inhalers. A minority of patients and some young children are unable to use dry powder inhalers, but most patients actually prefer powder inhalers as they are easier to use as they require less coordination than a metered-dose (spray) inhaler. Another advantage of dry-powder inhalers is that they usually have dose-counters, so you know how many doses are left and don’t mistakenly use an empty inhaler, or throw away a full one.

Nobody should settle for sub-standard treatment, and the most important thing is that your disease is well controlled. Patients with poorly controlled asthma not only suffer more symptoms and are more likely to be admitted to hospital, but they also have a larger carbon footprint of care – typically 3 times greater than patients with well-controlled asthma.  If you have asthma and are needing 3 or more blue inhalers a year, talk to your healthcare professional about how to get better control of your disease. Make sure you are using your controller treatment regularly and effectively – you may need to step up to a more effective controller inhaler.

Real-world UK evidence suggests most patients would probably have better disease control on dry-powder inhalers. If you’d like to switch to a dry-powder inhaler, talk to your GP about the possible options, and above all make sure you have your inhaler technique checked to ensure you can use the new inhaler properly.

Dry powder inhalers

Dry powder inhalers don’t rely on hydrofluorocarbon propellants to spray the medication into your lungs; they rely on your breath to break up and disperse tiny particles of the medicine through your airways. That’s why these inhalers are not suitable for all patients; they require a hard, fast, deep breath in to work effectively, and not all patients can use them effectively. Young children, some elderly patients and those with a very weak breath in may struggle. For the majority of patients though, dry powder inhalers are an effective alternative and offer other advantages over metered-dose (spray) inhalers. This table summarises the main differences.

Will a dry powder inhaler be suitable for me?

This is a really important question to ask, but it’s one that can only be assessed properly by your healthcare professional. For the majority of patients, dry powder alternatives are available.

What type of inhaler is best?

This debate has been raging for a long time and will no doubt continue. There is no single right answer for all patients. Doctors can’t decide! National guidelines, for instance by NICE, advise that for adults both types of inhaler are as good as each other.

Here are some facts to consider though:

  1. Not everyone has a strong enough flow of breath to use dry-powder inhalers. For these patients, metered-dose inhalers are usually needed, but occasionally nebulisers or aqueous mist inhalers may be appropriate. This mainly applies to young children and those with severe disease.
  2. In the UK about 70% of inhalers are metered-dose inhalers, whilst in every other country in Europe, these inhalers are used less than 50% of the time; in Sweden it’s about 13%. The UK also has some of the worst death rates in Europe for asthma and COPD, making it hard to argue that metered-dose inhalers provide any significant benefit.
  3. Respiratory specialists are more likely to prescribe dry powder inhalers than general practitioners, who use more metered-dose inhalers.
  4. Many metered-dose inhalers lack a dose counter, so it’s hard to know if they’ve run out. Many patients unknowingly continue using their inhaler, even though they are mainly breathing in propellant and very little actual medication. Real life problems like this don’t often happen in clinical trials where patients are monitored more closely.
  5. Even with repeated training, many patients still fail to use inhalers correctly, regardless of the type of inhaler. Most commonly, patients inhale too fast with an metered-dose inhaler and many inhale too slowly with a dry powder inhaler.


Respimat inhalers are sometimes useful as an alternative to metered dose inhalers or dry powder inhalers. They use a watery mist, driven by a spring to propel medication into your lungs. Unlike metered dose inhalers they don’t use environmentally damaging propellants, so they have a small carbon footprint. They can be refilled for up to  6 months which further reduces waste. They can be used by people who don’t have powerful enough breath in to use dry powder inhalers. Unfortunately, they are only useful in certain conditions (mainly COPD – smoking-related lung disease) and aren’t available as inhaled steroids or reliever inhalers in the UK. Some people find them a bit fiddly to activate, but with the right instruction, almost everyone can use them.

I still need to use a Metered Dose Inhaler

There is still a lot you can do to reduce its environmental impact. Read on here.