The full methodology is available as a preprint at medrxiv (external link). This methodology was then used to develop the RDTC’s Inhaler Carbon Footprint tool.


The impact of climate change on health is increasing, as global warming continues to rise. Within the health and social care sector, pressurised metered dose inhalers (pMDIs) and breath-actuated pMDIs (BA-pMDIs) have been identified as a significant contributing factor to England’s National Health Service carbon footprint.

A grounded theory study design was applied to formulate a process map and methodology for inhaler carbon footprint estimation, utilising established inhaler carbon footprint values and pharmaceutical principles.

A methodology has been developed to support estimation of inhaler carbon footprint values for those inhalers and refills, that do not have a manufacturer’s independently verified carbon footprint certificate.

Definitive inhaler carbon footprint values, such as those reported here, are required to enable analysis and monitoring of prescribing against Net Zero targets. Further application can also support sustainability assessment and formulary decision making.