Some asthma inhalers emit greenhouse gases. But can patients afford to switch? : Shots - Health News Some doctors are promoting propellant-free inhalers over puff inhalers that emit greenhouse gases. Climate change can exacerbate respiratory ills because of more fires, air pollution and allergens.

Could better asthma inhalers help patients, and the planet too?

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Inhalers can be lifesavers for people with asthma and other lung diseases. People in my family have used them. But propellants in the most common type of inhaler, like the little canisters of inhalers, are powerful greenhouse gases, at least 1,500 times more potent than carbon dioxide, so some doctors are introducing patients to more climate-friendly options that might also be better for their health. Martha Bebinger from WBUR reports.

MARTHA BEBINGER, BYLINE: Dr. Miguel Divo, a lung specialist, is meeting with a patient in a noisy exam room at Brigham and Women's Hospital in Boston. He's holding the little boot-shaped inhaler used by the vast majority of U.S. asthma patients. Pressing down on the canister shoots medicine into their lungs.

MIGUEL DIVO: And what we have is a gas propellant, a gas that is very harmful for the environment.

BEBINGER: That's astonishing news for most patients, including the one Divo is seeing today, Joel Rubinstein.

JOEL RUBINSTEIN: Absolutely never occurred to me, especially - I mean, these are little teeny things.

BEBINGER: About 144 million gas propellant inhalers are sold in the U.S. annually. They release the heat-trapping equivalent of half a million cars on the road each year, so Divo reviews the alternative. This one looks like a hockey puck. Patients suck powdered medicine in using their own lung power, no greenhouse gases needed.

DIVO: Joel, would you be OK to use this one, which is a powder form? So you open and you can just inhale, and it's the same medication that helps with the asthma control.

BEBINGER: Still, Rubinstein, a retired psychiatrist, said no the first time Divo asked because the dry powder inhaler would have been much more expensive. Then his insurer increased the co-pay on the gas propellant inhaler, and Rubinstein decided to give the dry-powder option a try.

RUBINSTEIN: For me, price is a big thing. Now, the powder is a very strange thing, to blow powder into your mouth and lungs.

BEBINGER: Research shows that adapting may be worth it. Patients in the U.K. and Sweden who use these inhalers have better asthma control, but Divo says only about 25% of his patients even consider switching because there may be downsides. Dry powder inhalers can still be more expensive. Not all meds are available in this form, and dry powder is not recommended for young children. Still, when appropriate, Divo asks if patients would consider a switch. He's being encouraged in this effort by Brigham and Women's, which, like some hospitals, is looking for ways to dramatically cut emissions.

DIVO: There is one planet, and there is one human race. We are creating our own problems, and we need to do something.

BEBINGER: Problems because traditional inhalers contribute to climate change, which means more heat, fires, pollution and longer allergy seasons, all things that can increase use of inhalers. Dr. Albert Rizzo is medical director at the American Lung Association.

ALBERT RIZZO: That's the Catch-22. The climate crisis makes these individuals have higher risks of exacerbation and worsening their disease, and we don't want the medications they're using to contribute to that.

BEBINGER: Cost could remain a major barrier as manufacturers try to make inhalers more environmentally friendly with new gas propellants. Last time they changed gases, in the early 2000s, prices shot up, and some patients cut back on puffs to save money. Dr. Gregg Furie, also at the Brigham, is worried that's about to happen again.

GREGG FURIE: So while these new propellants are potentially a real positive development, there's also a significant risk that we're going to see patients and payers face significant cost hikes.

BEBINGER: Finding the most effective, affordable and climate-friendly inhalers amid all of these changes will be challenging for doctors and their patients.

For NPR News, I'm Martha Bebinger in Boston.

INSKEEP: This story comes from NPR's partnership with WBUR and KFF Health News.

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