{
  "abstract": "Background The healthcare sector contributes significantly to global greenhouse emissions, with inhalers being major contributors.Objective To develop a framework for reducing the environmental footprint of inhalers in Spain by implementing greener prescription practices.Methods A multidisciplinary working group was formed, including hospital pharmacists, pulmonologists, and environmental experts. We created a comprehensive database on the environmental impact of inhalers marketed in Spain, incorporating product specifications and environmental data from the Spanish Agency of Medicines and Medical Devices and pharmaceutical companies. We developed a decision-making algorithm integrating clinical and environmental criteria and performed scenario projections to estimate potential benefits of transitioning from pressurised metered-dose inhalers (pMDIs) to dry powder inhalers (DPIs) and other eco-friendly alternatives. Scenarios included global and individual projections, as well as comparisons between sustainable prescriptions and waste-management strategies.Results The national database revealed significant variability in the carbon footprint across inhaler types, with pMDIs showing the highest emissions. A shift of 10% from pMDIs to DPIs could reduce CO 2 emissions by approximately 40 000 tonnes/year, and a 50% shift by up to 200 000 tonnes. The decision-making algorithm effectively combined clinical and environmental considerations, facilitating the selection of more sustainable inhalers.Conclusion The study highlights the importance of incorporating environmental criteria into inhaler prescribing choices to reduce healthcare’s carbon footprint. Transitioning from pMDIs to DPIs when clinically indicated offers considerable environmental benefits without compromising patient health. The developed decision-making algorithm provides a practical tool for healthcare professionals, balancing clinical efficacy with sustainability. Future research should refine these practices and explore their application in other medical devices.",
  "authors": [
    {
      "affiliations": [
        "Department of Pharmacy, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain",
        "School of Health Science Blanquerna, Universitat Ramon Llull, Barcelona, Spain",
        "Faculty of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain"
      ],
      "name": "Noé Garin"
    },
    {
      "affiliations": [
        "Department of Pharmacy, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain",
        "Department of Medicine, Universitat Autonoma de Barcelona, 08025, Barcelona, Spain"
      ],
      "name": "Borja Zarate-Tamames"
    },
    {
      "affiliations": [
        "Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain"
      ],
      "name": "Unax Lertxundi"
    },
    {
      "affiliations": [
        "Department of Pharmacy, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain"
      ],
      "name": "Ivan Martin da Silva"
    },
    {
      "affiliations": [
        "NanoBioCel Research Group, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain"
      ],
      "name": "Gorka Orive"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"
      ],
      "name": "Astrid Crespo-Lessmann"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"
      ],
      "name": "David De la Rosa"
    }
  ],
  "title": "The environmental impact of inhalers: a framework for sustainable prescription practices in Spain",
  "uid": "e5cb71d6-bd1d-5f02-9a8f-00a4bfe5e737"
}