shutterstock_2143243899_1.jpegClimate change is a growing threat to population health especially with patients who have a respiratory illness by driving increased symptoms, exacerbations and health care use in both asthma and COPD.

Greenhouse gas emissions (GHG) are felt to be one of the culprits responsible for the changing state of our environment. I was surprised to learn that the US healthcare system is responsible for 10% of the national GHG emissions and 25% of the global healthcare emissions. A portion of these GHG emissions come from metered-dose inhalers using hydrofluorocarbon propellants. I was even more surprised to learn that one common rescue inhaler such as albuterol may contain the equivalent GHG emission as a gas-powered car driving more than 69 miles.

What can we do? First, patients should be tested to be sure they need inhaled medications. Studies have shown that as many as 44% of untested patients with COPD and 33% of asthma patients did not have the disease when they were tested objectively. Second, adherence to guideline-based care may reduce inhaler use. Lastly, ensuring proper inhaler technique since data suggest as much as 68% of patients use their inhaler incorrectly and inappropriately. Using a drypowered inhaler where possible is also a consideration.

These efforts may seem small when we consider the global benefit. We need to keep in mind that each small opportunity for change is worthwhile. Remember, the journey of a thousand miles begins with the first step. Patients and physicians can work on this first step.