Many medicines, likes anaesthetics and inhalers, are known to contribute significantly to health care’s emissions footprint. Consequently, staff at the Aga Khan Health Services (AKHS) are looking at ways to reduce the use of these products.

Anaesthetic Gases

In 2019, AKHS started identifying the types and volumes of anaesthetic gases it was using and making better substitutions wherever possible. As a result, AKHS health facilities have stopped using the most potent greenhouse gas, Desflurane. However, isoflurane, halothane, sevoflurane, and nitrous oxide, which are also problematic from the perspective of global warming, are still being used.

AKHS staff are actively working on reducing the impacts of these gases by:

• Wherever possible, changing from high carbon or ozone-depleting gases to lower carbon and more ozone-friendly alternatives;
• Exploring the reduction of nitrous oxide and replacement in surgery with oxygen or medical air;
• Increasing the use of low-flow anaesthesia to reduce the volumes used of all gases;
• Using alternatives to fluorinated gases, such as intravenous anaesthesia;
• Wherever possible, capturing and reusing anaesthetic gases.

A group of AKHS anaesthetists are working on implementing changes and sharing lessons learnt across the network. AKHS is also seeking opportunities to share information on the carbon footprint and ozone depletion qualities of anaesthetic gases with anaesthetists in private and public sectors to influence best practice more broadly.

Inhalers

It is well known that air pollution is a problem in many low and middle-Income countries where AKHS works, but what is not known is the fact that some treatments for respiratory illness can contribute to climate change.

In particular, pressurised Metered Dose Inhalers (pMDI) use gases to deliver medications which are potent greenhouse gases. The propellant gases used in pMDI are up to 3,350 times more potent than carbon dioxide as greenhouse gases. A single pMDI, if fully used, can release as much greenhouse gas emissions as a small car driven for 180 miles; a single patient may use more than 12 inhalers a year.

Fortunately, there are alternatives. Some propellant inhalers are better than others for delivering the same type of drug, either because they use less propellant or a less damaging propellant. In most cases, dry powder-based inhalers can be just as clinically effective and have a small fraction of the environmental impact. For these reasons, dry powder inhalers are predominantly (90%) prescribed in Sweden.

AKHS is reducing its own contributions to air pollution and the carbon impacts of respiratory care, including:

• Reducing the contribution of all its operations to air pollution (e.g. through smart choices of fuels used and incineration practices in health facilities).
• Reviewing how inhalers are prescribed, dispensed and used (oftentimes a third of the contents of inhalers are unnecessarily wasted by users).
• Favouring lower carbon or propellant free inhaler alternatives where clinically appropriate.
• Disposing of inhalers in environmentally safe way.