What is it about?
We examined more than 750,000 new inhalers dispensed to Ontario adults aged 65 years and older between 2017 and 2023. New inhaler use fell sharply at the beginning of the COVID-19 pandemic, then gradually returned toward pre-pandemic levels. Metered-dose inhalers remained the most commonly used devices, although the proportion of lower-emission dry powder inhalers increased modestly.
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Why is it important?
Metered-dose inhalers have a substantially larger carbon footprint than several clinically appropriate alternatives. Despite increasing guidance on lower-carbon prescribing, they still accounted for approximately 70% to 77% of new inhalers in this study. The findings identify a persistent gap between sustainability recommendations and routine care, supporting targeted measures to help clinicians and patients select effective, lower-emission inhalers when clinically suitable.
Perspectives
As a family physician, I see inhaler selection as a practical opportunity to improve care while reducing avoidable healthcare emissions. Our study suggests that awareness and clinical guidance alone have not substantially changed prescribing practices. The next step is to develop and evaluate pragmatic interventions that support shared decision-making, preserve clinical appropriateness, and make lower-carbon inhaler choices easier in everyday practice.
Anthony Train
Queen's University
Read the Original
This page is a summary of: Prescription patterns of inhaler medications from 2017 to 2023: A retrospective study using Ontario administrative healthcare data, PLOS One, June 2026, PLOS,
DOI: 10.1371/journal.pone.0348119.
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