• asthma
• pulmonary disease
• chronic obstructive

It is estimated that health services account for around 4% of national carbon emissions and that propellants from metered dose inhalers (MDIs) are responsible for 3%–4% of the National Health Service’s (NHS) carbon footprint.1–4 Concerns over the environmental impact of MDIs have led to a series of short-term and long-term targets on their use. In 2018, the House of Commons’ Environmental Audit Committee recommended that by 2020, at least 50% of MDIs are recycled and that by 2022 at least 50% of prescribed inhalers are of low global warming potential.3 In January 2019, the NHS Long Term Plan set targets to reduce carbon emissions from the NHS by moving to lower carbon inhalers and is supported with information and resources produced by the National Institute for Health and Care Excellence and the British Thoracic Society.2 4 …