Imagine struggling to breathe, your lungs burning, only to realize the very treatments helping you are also making the problem worse. That's the harsh reality for millions facing respiratory issues exacerbated by climate change. From asthma attacks triggered by pollution to lung damage from wildfire smoke, our health is directly impacted, and the healthcare systems we rely on are, ironically, contributing to the global warming that fuels these problems.
Climate change isn't just an abstract threat; it's a respiratory crisis in the making. We're seeing a surge in respiratory diseases, primarily due to worsening air pollution, more intense heat waves, devastating wildfires, and extended pollen seasons. And this is the part most people miss: it's not just about the future. It's happening now.
Consider this: Over 90% of the world's population breathes air that exceeds the World Health Organization's (WHO) recommended limits for particulate matter. That's a staggering statistic, highlighting the pervasive nature of air pollution. Experts are increasingly pointing to environmental factors as significant contributors to respiratory illnesses. Think about it – every breath we take is potentially laden with pollutants.
The connection is undeniable. Increasing wildfires and air pollution are fundamentally altering the air we breathe, leading to increased risks of exacerbations (flare-ups), disease progression, and even the initial onset of respiratory illnesses. Dr. Therese Laperre, head of the respiratory department at the University Hospital Antwerp, emphasizes that climate change is acting as a multiplier, triggering more frequent and severe asthma and chronic respiratory disease flare-ups, as well as altering patterns of respiratory infections. "We know that changes in particulate matter [air particles that can harm human health] have an impact days later on emergency department visits of patients with asthma and chronic pulmonary disease," she explains, highlighting the immediate and measurable impact of air quality on respiratory health.
A sobering study by the European Environment Agency estimated that over one-third of all chronic respiratory disease deaths in Europe are linked to environmental factors, including air pollution, extreme temperatures, wildfire smoke, and allergenic pollen. This paints a grim picture of the direct link between our environment and our respiratory well-being.
A Vicious Cycle of Health and Climate
The scale of the problem is immense. Globally, an estimated 400 to 500 million adults live with Chronic Obstructive Pulmonary Disease (COPD), and over 250 million people live with asthma. Now, here’s where it gets controversial... The very healthcare systems responding to this growing burden contribute significantly to the problem. Health Care Without Harm, a non-profit international organization, estimates that global health services generate about five percent of worldwide greenhouse gas emissions. To put that in perspective, if global healthcare were a country, it would rank among the world's top polluters!
If we don't take action, emissions from healthcare are projected to reach a staggering six gigatons a year by 2050. That's the equivalent of adding over a billion cars to our roads. Hospitals, particularly intensive care units (ICUs), are major contributors to this environmental impact. ICUs are some of the most polluting areas within hospitals on a per-patient basis. This is because they require vast amounts of energy, specialized equipment, and large quantities of single-use materials. All of these things release significant amounts of greenhouse gases.
Respiratory specialists are increasingly recognizing that early and effective management of chronic respiratory diseases is not only beneficial for patients but also crucial for reducing healthcare's climate footprint. As Philippe Tieghem, from the French respiratory association Sante Respiratoire, puts it, "If we are detecting earlier, we are controlling earlier, it's good for patients, it is good for carbon, it is good in an economic vision as well." Early diagnosis and intervention are climate measures, not just clinical ones.
Inhalers: A Perfect (and Problematic) Example
Inhalers, commonly used to treat long-term lung diseases like COPD and asthma, perfectly illustrate this dilemma. The most prevalent type, pressurized metered-dose inhalers (pMDIs), are small aerosol sprays that use gas to propel medicine directly into the lungs. The problem? The propellants – the gas that sprays the medicine – are typically hydrofluorocarbons (HFCs), which are potent fluorinated greenhouse gases with a high global warming potential.
Recent estimates suggest that pressurized inhalers release approximately 4–5 million tonnes of CO₂-equivalent per year in Europe and around 16–17 million tonnes globally, accounting for about 0.03 percent of total greenhouse gas emissions. While this may seem small, the United Kingdom's National Health Service estimates that these inhalers contribute around three percent of its own carbon footprint. That's a significant portion for a single type of medical device.
These numbers, while relatively small on a global scale, are significant enough for healthcare services and manufacturers to prioritize the decarbonization of inhalers, focusing on engineering traditional devices to use "greener gases." So far, only one of these next-generation products has reached patients: AstraZeneca's reformulated COPD inhaler, approved for use in the UK and the European Union. This inhaler contains the same three active medicines and is used in the same way as its predecessor, but the propellant has been switched from the old HFA-134a to a new gas called HFO-1234ze(E). This seemingly small change results in a dramatic reduction in the inhaler's warming impact – about 99.9 percent compared to the old gas, representing roughly a 1,000-fold reduction in global warming potential.
New Efforts to Reduce Environmental Impact
AstraZeneca has also pledged to cut its emissions by 98 percent by 2026, starting with inhalers and addressing scope 3 emissions linked to suppliers and product use. Pablo Panella, senior vice-president for respiratory diseases at AstraZeneca, explains their mission: "We do have a mission, working on prevention in early detection, early diagnosis, and early treatment, to ensure that we use our medicine to keep patients controlled in the community and free up hospital capacity that tends to be a lot more costly and more critical, particularly in acute situations.”
Other major drugmakers are following suit, pledging to cut their emissions and shrink their environmental footprint. Pfizer has committed to a company-wide climate plan to reach net-zero by 2040, and Johnson & Johnson has the same goal for 2045. The core idea is that better control of chronic disease leads to fewer emergency admissions and less need for resource-intensive care.
Pharmaceutical companies are starting to talk about the concept of a “green patient” – someone whose disease is well-controlled enough to avoid repeated flare-ups, hospital stays, and high-carbon interventions. For the industry, technology is only part of the solution. The other critical factor is regulation that facilitates the adoption of low-carbon options for patients. Panella emphasizes that regulations need to be welcoming and facilitating, as overly complex and cumbersome regulations can hinder the adoption of innovative technologies, delaying their availability to patients.
When it comes to climate-conscious regulation, the question shouldn't be whether to move in that direction, but how to design regulations that foster a welcoming ecosystem for the industry to continue investing in and bringing forth innovation. What do you think? Should regulations prioritize environmental concerns even if it means potentially slowing down the development and release of new medications? Or should the focus remain primarily on patient access to the best available treatments, regardless of their environmental impact? Share your thoughts in the comments below!
