Carbon footprint impact of Breezhaler® dry powder inhaler: a life cycle assessment in the UK

Aim:Delivery of respiratory inhalers makes a significant contribution to the carbon footprint (CFP) of healthcare. Consistent with Novartis’ commitment to reduce the environmental impact of its products, the inhaler used in its asthma combinations is available in the hydrofluoroalkane/chlorofluorocarbon (HFA/CFC)-free Breezhaler® device.Methods: Cradle to grave CFP studies of two Breezhaler® inhaled combinations have been completed: one containing indacaterol acetate (IND) and mometasone furoate (MF); and the other IND, MF and glycopyrronium bromide (GLY). The CFP is verified as compliant with the Greenhouse Gas Protocol Product Life Cycle Accounting and Reporting Standard Sector Guidance for Pharmaceuticals and Medical Devices. CFPs are appraised for Germany, France, UK and Japan in a 30-day pack (both products) and a 90-day pack (IND/GLY/MF). For the 30-day pack, an optional sensor is offered, which is a part of the digital companion of the Breezhaler® device and the property of Propeller Health Ltd, USA. The study boundary excluded the benefits of the drugs and the optional sensor in terms of asthma exacerbations, rescue medication and adherence.Results: In the UK, CFPs for Breezhaler® device range from 0.19 kg CO2 eq per month for IND/GLY/MF (90-day, no sensor) to 0.499 kg CO2 eq per month for IND/GLY/MF (30-day, with sensor). Of the 30-day devices, IND/GLY/MF (no sensor) has the lowest CFP (0.382 kg CO2 eq per month). The details of CFP comparisons are presented in Table 1.Conclusions: Active pharmaceutical ingredients, Breezhaler® device raw materials and packaging make the largest contributions to the CFP, sensor raw materials dominating where used. Excipients, distribution and end of life stages all make minimal contributions to the carbon footprint for all of the Breezhaler® device models. Overall, when considering inhalation therapy environmental impacts, the assessed Breezhaler® portfolio has a low CFP, consistent with the literature on dry powder inhalers. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest Karen Mezzi and Brett Fulford are employees of Novartis Pharma AG, Basel, Switzerland. Simon Aumônier is a Partner at ERM, and Andy Whiting and Samuel Norris are consultants at ERM. ERM is a global sustainability consulting business that works widely on a broad range of assignments for clients across all sectors of the economy. Its work has included pro bono contributions and consulting assignments for the Sustainable Healthcare Coalition and consulting engagements with many pharmaceutical and medical device companies, including Novartis Pharma AG. The study was funded by Novartis Pharma, AG, Basel, Switzerland. References and Clinical Trial Registry Information