Transitioning our medicines delivered by pMDIs to our next-generation propellant is critical to deliver more sustainable respiratory care and optimise patient outcomes

ORIGINALLY PUBLISHED:
12 May 2025

Written by:

Andrew Menzies Gow

Vice President, Respiratory and Immunology for Global Biopharmaceuticals Medical

We are on track to transition our portfolio of inhaled respiratory medicines delivered by pressurised metered-dose inhalers (pMDIs) to our next-generation, near-zero Global Warming Potential (GWP) propellant by 2030, as part of our Ambition Zero Carbon strategy.

Advancing more sustainable respiratory care with low GWP inhaler innovation

Key takeaways

  • pMDIs remain essential because they are clinically necessary for many patients, widely used (~78% of inhalers globally), and recognised as essential medicines by WHO.1,2
  • Poor disease control and hospital care drive emissions: In the UK, compared with controlled asthma, uncontrolled asthma has ~3× higher carbon impact (contributing over 300,000 tonnes CO₂ annually), and COPD inpatient care generates ~75% more emissions than outpatient management.3,4
  • Patient outcomes must drive decisions: medicines and the devices they are supplied in should not be considered interchangeable. New evidence shows that switching inhalers for non-clinical reasons may worsen disease control and increase healthcare burden.5
  • The next-generation propellant has ~99.9% lower GWP compared to the propellant used in traditional pMDIs, delivering near-zero GWP without changing the medicine or patient experience.6
  • AstraZeneca has committed to transition its portfolio of medicines delivered by pMDIs to the next-generation propellant as quickly as possible, starting in 2025, and is on track to complete the transition by 2030. The transition of the first pMDI medicine with a near-zero GWP has been completed in the UK and is underway across Europe, with ongoing global filings (including the US, Japan & China).7,8

The climate challenge must also be understood as a health challenge, requiring a coordinated and systemic response. As a healthcare community, we have a responsibility to contribute to solutions that both improve patient outcomes and support the sustainability of our health systems.

People living with chronic respiratory diseases are particularly exposed to the combined effects of environmental and health pressures.9-11 Air quality and extreme weather events are already contributing to the growing burden of conditions such as asthma and chronic obstructive pulmonary disease (COPD).11-13 At the same time, the care pathways these patients rely on—while essential—also have an environmental footprint, across healthcare utilisation and the use of medicines.14

We have an opportunity to do more to protect patients, build health systems resilience and reduce our impact on the planet. Through innovations such as CARESA, which models the environmental impact of patient care pathways, we can better understand where change is needed.15 We believe that reducing the environmental burden of respiratory care starts with optimising disease management and improving patient outcomes in partnership with the respiratory community, while at the same time, transitioning to pMDIs with reduced environmental impact as part of our Ambition Zero Carbon strategy.

How will pMDIs using a next-generation near-zero GWP propellant help advance sustainable respiratory care?

Globally, millions of people living with chronic respiratory diseases, such as COPD and asthma, rely on pMDIs to deliver essential medicines to the lung.2 These medicines, which account for 78% of global inhaler use, are listed as essential by the World Health Organization and are an important therapeutic option for patients.1,2 This is particularly true where familiarity with the device, limited lung function, young or advanced age,  are considerations.16-18 Additionally, recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Global Initiative for Asthma (GINA) prioritise pMDI use in emergency settings where appropriate, further demonstrating the critical role pMDIs play in respiratory medicine.19,20

Although not widely understood, inhalers explain only a modest part of the total carbon footprint in many chronic respiratory conditions. Uncontrolled asthma and COPD lead to extensive healthcare resource use and a higher carbon footprint.5 For example, the first real-world evidence study to quantify GHGs from asthma care, SABINA CARBON UK, showed that patients with poorly controlled asthma have a carbon footprint three times higher than those whose asthma is well controlled.3 Further, in cases like COPD, the EXACOS CARBON study of people in the UK showed hospital-based care contributed the most to GHG emissions (approximately 75% including inpatient admissions and excluding emergency department visits), and emissions increased with exacerbation frequency and severity.4 In that sense, ensuring patients’ disease remains controlled on their medication is one of the most effective ways to achieve not only the best clinical outcomes, but also to support sustainable care.

Poorly controlled disease and exacerbations have a disproportionate impact on patients,
healthcare systems and the environment3,4

cough icon

>303,874 tonnes of CO2 per year

from poorly controlled asthma care – equivalent to emissions from >124,000 houses in the UK3

graph increase icon

3x higher carbon footprint

from asthma patients with poor disease control compared to well-controlled patients3

collaboration icon

~75% more GHG emissions

from hospital COPD inpatients compared to COPD outpatient, emergency or primary care4

lung icon

For COPD patients, GHG emissions tend to increase

alongside exacerbation frequency and/or severity when considering care for COPD patients4

In respiratory, a green patient is the one whose respiratory condition is well controlled. Implementing evidence-based guidelines is a powerful way to achieve disease control, prevent exacerbations and hospitalisations, and thereby reduce the overall carbon footprint of care. As a respiratory community, our focus must be on the right medicine for the right patient so that we don’t put people or health systems under unnecessary strain.

Arzu Yorgancıoğlu Head of Department of Pulmonology, Celal Bayar University, Turkey

That said, we believe more can be done, which is why we are leading the way and accelerating the development of our next-generation propellant with a significantly reduced environmental impact. This is in line with our aim to reduce our Scope 3 emissions by 35% by 2030.7 Reflecting our commitment to sustainable science, we are planning the transition of our portfolio of medicines delivered by pMDIs to an innovative, next-generation propellant, which has near-zero GWP – 99.9% lower than those traditionally used.7

As pMDIs remain an essential option in respiratory care, this will ensure treatment decisions can continue to be driven by clinical need.2 Making these medicines available with the next-generation propellant means that clinicians and their patients can select the most appropriate treatment with less environmental impact.

In early 2026, all patients in the UK successfully transitioned to our first medicine using the next-generation propellant. The transition of patients to the first pMDI medicine with a near-zero GWP across the EU is underway and due to complete this year, with other countries to follow, pending regulatory approvals.

Thanks to innovative science, the transition to a near-zero Global Warming Potential propellant in our pMDIs will ensure patient needs are met and improve healthcare professionals’ ability to optimise care by maintaining access to essential medicines, while simultaneously supporting healthcare systems reduce their emissions. With our next-generation propellant pMDIs, we can address the needs of patients while supporting more sustainable respiratory care.

Caterina Brindicci Senior Vice President & Global Head Research and Development, R&I

How can medicines delivered by pMDIs using our next-generation propellant support better patient outcomes?

For chronic diseases like asthma and COPD, optimising patient care and improving clinical outcomes must be the priority in any treatment decision.5 Treatment should be informed by discussion between a patient and their healthcare provider and focused on clinical needs.21 The medicines in the devices should not be considered interchangeable, therefore switching inhaler regimens can negatively impact patient outcomes.22

The transition to medicines delivered by pMDIs with the next-generation, near-zero GWP propellant ensures that clinicians can select the most appropriate medicine for their patient without having to consider the impact of the inhaler on the planet. By getting the right medicine to the right patient, we’re improving care, keeping patients out of hospital and helping to reduce the carbon footprint of respiratory care.

Back to our media articles

You may also like

Respiratory & Immunology
Sustainability at AstraZeneca

References

  1. Bell J, et al. An Assessment Of Pressurized Metered-dose Inhaler Use In Countries In Europe And The Rest Of The World. Poster Presentation at American Thoracic Society (ATS) international congress, 2023 May.
  2. World Health Organization Model List of Essential Medicines – 23rd List, 2023. In: The selection and use of essential medicines 2023: Executive summary of the report of the 24th WHO Expert Committee on the Selection and Use of Essential Medicines, 24 – 28 April 2023. Geneva: World Health Organization; 2023.     
  3. Wilkinson et al., Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe‒Based envirONmental cost of treatment (CARBON) study. Thorax. 2024;79(59):412-21.
  4. Bell J, et al. A54 EXACOS CARBON: Describing the Greenhouse Gas Emissions of Healthcare Resource Utilization by Frequency and Severity of COPD Exacerbation in England (abstract). American Journal Respiratory Critical Care Medicine. 2024;209:A2113.
  5. Hurst, J, et al. Prioritising patients and planet: advocating for change in respiratory care. EMJ Respiratory. 2024;12(1):51-62.
  6. AstraZeneca Pharmaceuticals. Data on File. ID: REF-140251
  7. AstraZeneca. Sustainability Impact Report. https://www.astrazeneca.com/content/dam/az/Sustainability/2026/pdf/AZ-Sustainability-Impact-Publication-2026.pdf. [Accessed August 2026].
  8. Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 21-24 July 2025, 21 – 25 July 2025. European Medicines Agency; 2025.
  9. WHO. Climate change and health. [Online]. Available at: https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health. [Accessed August 2026].
  10. The Lancet Respiratory Medicine: editorial. Climate change crisis goes critical. Lancet Respir Med. 2023;11(3):213.
  11. Deng SZ et al. Chinese Medical Journal. 2020 Jul 5;133(13):1552-60.
  12. WHO. Ambient (outdoor) air pollution. [Online]. Available at: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health. [Accessed August 2026].
  13. Wu Y, et al. Global Burden of Respiratory Diseases Attributable to Ambient Particulate Matter Pollution: Findings From the Global Burden of Disease Study 2019. Front. Public Health. 2021;9:740800. doi: 10.3389/fpubh.2021.740800.
  14. Tennison I, et al. Health care's response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. 2021;5(2): e84-e92.
  15. AstraZeneca. CARESA – a pioneering tool to model the environmental impact of patient care pathways. [Online]. Available at: https://www.astrazeneca.com/media-centre/articles/2025/caresa-a-pioneering-tool-to-model-the-environmental-impact-of-patient-care-pathways.html. [Accessed August 2026].
  16. Lavorini F. The challenge of delivering therapeutic aerosols to asthma patients. ISRN Allergy. 2013; 102418.
  17. Laube BL, et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37(6):1308-31. 
  18. Lavorini F, et al. Optimising inhaled pharmacotherapy for elderly patients with chronic obstructive pulmonary disease: the importance of delivery devices. Drugs Aging. 2016;33(7):461–73.
  19. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, 2026. [Online]. Available at: https://ginasthma.org/2026-gina-strategy-report/. [Accessed August 2026].
  20. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for prevention, diagnosis and management of COPD. 2026. [Online]. Available at: https://goldcopd.org/2026-gold-report-and-pocket-guide/. [Accessed August 2026].
  21. Usmani et al. Consensus quality standard for implementing inhaler regimen switch in patients with respiratory disease. European Respiratory Society Congress 2023. Poster # PA4607.
  22. Bjermer L. The importance of continuity in inhaler device choice for asthma and chronic obstructive pulmonary disease. Respiration. 2014;88(4):346-352.

Veeva ID: Z4-72347
Date of preparation: August 2026

tags

  • Sustainability