{
  "abstract": "Background People with lung diseases are vulnerable to climate change, yet metered dose inhalers (MDIs) have significant climate impacts. We sought to understand inhaler users’ perspectives on climate change and awareness of inhaler climate implications.Methods Canadians (aged ≥16 years) who reported using an inhaler in the previous 6 months were invited via health organisations’ newsletters to complete an online survey (November 2024–March 2025). Multivariate regression models assessed the association between sociodemographic factors and climate change risk perception, disposal practices and awareness of inhaler climate implications.Results There were 343 respondents (median age 71 years (IQR: 64–76 years), 65% female, 80% MDI users). Individuals were concerned (45%) or very concerned (39%) about climate change, but only 20% were previously aware of inhaler climate implications. Advancing age (OR 0.58, 95% CI 0.45 to 0.74) was associated with being unaware of inhaler climate implications, while a university education (OR 4.86, 95% CI 1.77 to 16.62) and living in a large urban area (OR 2.81, 95% CI 1.21 to 7.45) were associated with greater awareness. Most respondents reported disposing of their inhalers in garbage or recycling bins (70%) and provincial pharmacy return programmes were underused (27%) when available. Nearly all MDI users (92%) were willing to switch to a lower carbon footprint device. Advice from healthcare providers was valued in supporting treatment decisions.Interpretation Inhaler users are concerned about climate change but lack awareness of inhaler climate impacts. Sustainability interventions that promote education, safe use of low carbon devices and recycling could reduce inhaler-related climate impacts.",
  "authors": [
    {
      "affiliations": [
        "Division of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Stacey J Butler"
    },
    {
      "affiliations": [
        "Division of Respirology and Sleep Medicine, Queen’s University, Kingston, Ontario, Canada"
      ],
      "name": "Geneviève C Digby"
    },
    {
      "affiliations": [
        "Canadian Association of Pharmacy for the Environment, Regina, Saskatchewan, Canada"
      ],
      "name": "Caitlin Roy"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Respiratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada"
      ],
      "name": "Sze Man Tse"
    },
    {
      "affiliations": [
        "Canadian Association of Pharmacy for the Environment, Ottawa, Ontario, Canada"
      ],
      "name": "Shellyza Sajwani"
    },
    {
      "affiliations": [
        "Lung Saskatchewan, Saskatoon, Saskatchewan, Canada"
      ],
      "name": "Jill Hubick"
    },
    {
      "affiliations": [
        "Canadian Society of Respiratory Therapists, Ottawa, Ontario, Canada"
      ],
      "name": "Carolyn McCoy"
    },
    {
      "affiliations": [
        "Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Ivy Lam"
    },
    {
      "affiliations": [
        "Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Alexander Singer"
    },
    {
      "affiliations": [
        "Family Physicians Airways Group of Canada, Aurora, Ontario, Canada"
      ],
      "name": "Alan Kaplan"
    },
    {
      "affiliations": [
        "Division of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Eva Leek"
    },
    {
      "affiliations": [
        "Sinai Health System, Toronto, Ontario, Canada"
      ],
      "name": "Sakina Walji"
    },
    {
      "affiliations": [
        "The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"
      ],
      "name": "Valeria Stoynova"
    },
    {
      "affiliations": [
        "University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada"
      ],
      "name": "Erika Penz"
    },
    {
      "affiliations": [
        "Division of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Samir Gupta"
    }
  ],
  "title": "Understanding inhaler users’ perceptions of climate change and inhaler carbon footprints: insights from a Canadian survey",
  "uid": "644bf6b4-ec79-51e0-9de2-759c91e25dfe"
}