Swap your inhaler, skip the laughing gas: How patients can help curb health-care emissions

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Our planet is changing. So is our journalism. This story is part of a CBC News initiative entitled Our Changing Planet to show and explain the effects of climate change and what is being done about it.

If you’re struggling to breathe or heading into surgery, concerns about climate change are likely not top-of-mind compared to worries about managing your own health.

But rather ironically, the health-care sector contributes to climate change by giving off a sizeable chunk of greenhouse gases — and medical experts say both health-care providers and patients can do more to curb those emissions 

Health-care emissions make up about five per cent of Canada’s greenhouse gases, according to family physician Dr. Samantha Green, a board member with the Canadian Association of Physicians for the Environment. 

“We can do a lot within health care to lower those emissions and hopefully, therefore, decrease climate-related injury, climate-related illness and climate-related death,” Green said. 

  • Have questions about COP26 or climate science, policy or politics? Email us: ask@cbc.ca. Your input helps inform our coverage.

For example, while global leaders gathered at the COP26 climate conference in Glasgow on Monday, the World Federation of Societies of Anaesthesiologists released a consensus statement calling on anesthesia providers to boost environmental sustainability in their practices — by, among other options, choosing gases that have less environmental impact. 

Growing concern about health-care emissions has also prompted some Canadian medical professionals to launch awareness campaigns for both their colleagues and patients, offering avenues to switch or limit use of emission-producers.

From at-home medical devices, to anesthetic gases at the dentist’s office or an operating room, there are multiple ways to make swaps or cut back.

Inhalers for asthma, COPD

Dr. Kimberly Wintemute is among the Canadian physicians on a crusade against one small device that poses a surprisingly big problem: inhalers.

Older styles of metered-dose inhalers contain high levels of hydrofluorocarbons which act as greenhouse gases when released into the atmosphere, according to the Centre for Sustainable Health Systems (CSHS), which is running a sustainable inhaler initiative led by Wintemute.

With millions of Canadians requiring inhalers for conditions like asthma or chronic obstructive pulmonary disease (COPD), she says the emissions add up — with research showing that 100 puffs of a metered-dose inhaler equals close to a typical 300-kilometre car journey in terms of emissions. 

“We’d like to see a shift toward the dry-powder inhaler, and away from the metered-dose inhaler, for as many patients as we can,” said Wintemute. “And then we’d also like to address the problem of too many inhalers being prescribed.”

The sustainable inhaler initiative is hosting seminars for health-care professionals to break down the various inhaler options that don’t spew out hydrofluorocarbons, in hopes more physicians will make the switch when prescribing.

“I think that a lot of medicine keeps on happening out of habit,” said Wintemute.

“So, for some reason, that metered-dose, aerosolized inhaler has become the habit, [the] kind of default inhaler in North America and in other parts of the world.”

While certain young or older patients may require the ease of a pressurized metered-dose inhaler, many others can request a dry-powder option, she added.

People who use a metered-dose inhaler should also make sure they’ve been properly diagnosed and actually require the device on an ongoing basis, Wintemute said.

If you don’t need it, ditch it; and if you do need it, it’s worth asking your physician about more environmentally friendly options.

Metered-dose inhalers, like the one on the left, contain high levels of hydrofluorocarbons which act as greenhouse gases when released into the atmosphere, unlike dry-powder inhalers, like the one on the right. (Lauren Pelley/CBC)

Surgical anesthetic gases

Anesthetic gases used during surgery such as sevoflurane and desflurane also contribute to climate change.

Just one hour of sevoflurane use, for instance, equals roughly a 50-kilometre car journey, according to the CSHS, while an hour of desflurane use equals a 370-kilometre trip — with the latter having a climate impact more than 2,500 times that of carbon dioxide.

The gases are otherwise very similar, though sevoflurane is said to smell better.

Dr. Ali Abbass, an anesthesiologist at St. Joseph’s Health Centre in Toronto, says specialists should aim to use the lowest amounts required and, in some cases, choose other options entirely, such as a regional anesthetic.

“If you’re having arm surgery, [physicians can] weaken your arm with some local freezing anesthetic and get your surgery done without any anesthetic gas,” he said.

“There’s also general anesthesia one can do — instead of inhaled gases, with intravenous anesthetics.”

Ideally, Abbass continued, those decisions don’t fall only on medical teams, but also the patients.

“There’s so much momentum in health care, sustainability and environmental stewardship, we want to now also involve the patient in this discussion,” he said.

‘Laughing gas’ at the dentist

Anesthetic gases are also often a routine part of dental surgery. 

In particular, nitrous oxide — or laughing gas — is no laughing matter when it comes to climate change. As an anesthetic, it was responsible for roughly 80,000 tonnes of emissions in just Ontario in 2015.

Dr. Michelle Wong, director of the graduate specialty program in dental anesthesia at the University of Toronto, says there’s a growing trend to reduce use of anesthetic gases when possible, in part for environmental reasons but also to improve patient care.

Dr. Ali Abbass, an anesthesiologist and chief of environmental stewardship and sustainability at St. Joseph’s Health Centre in Toronto, holds IV bags that are being recycled as part of a recycling program. (Yuri Markarov/Unity Health Toronto )

“The recovery from intravenous agent use is much nicer,” she said. “Its ease of use, the profile of the recovery, how the patient feels afterwards — they’re less groggy or lethargic without the anesthetic gases.”

But what’s tricky, Wong added, is that most patients who request general anesthesia for dental work have a fear of needles.

“There’s lots of variables at play in the decision about using gases or IV agents,” she said.

For many patients, encountering emission-producing aspects of the health-care system remains inevitable — yet advocates in the medical community are hopeful that greener options will become more the norm in the future.

“It’s not all or nothing,” said Green, from the Canadian Association of Physicians for the Environment.

“Every little bit of reduction that we can make from within the health-care sector — and outside the health-care sector — actually will translate into people who will not get sick from asthma, people who will not have to evacuate a community because of a flood. And I think that’s hopeful.”


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