Reducing the Climate Impact of Metered-Dose Inhalers in Primary Care
- Jul 31
- 2 min read
Written by: Dr. Nicola Tam & Morgan Flynn, PCN Pharmacist
In September 2025, Dr. Nicola Tam and Morgan Flynn launched a quality improvement project to reduce carbon emissions from inhalers in Dr. Tam's family practice. The project was a success, and they are sharing their experience to help other family physicians interested in implementing similar changes.
Metered-dose inhalers (MDI's), which are high-carbon, are frequently overprescribed in primary care, often when lower carbon alternatives are equally effective and cost-effective. Switching just one MDI to a lower carbon alternative saves the equivalent of a 135km car trip! Family physicians find it challenging to engage patients in conversations around inhaler indication and switching due to time and resource constraints.
This quality improvement project included testing two interventions in Dr. Tam's family practice. First, we created electronic medical record (EMR) automated tools (e.g. a high-carbon inhaler “Alert”). Second, we optimized our team-based care by identifying patients who use high-carbon inhalers and offering a consultation with our PCN pharmacist. The pharmacist reviewed their respiratory health and inhaler use and adapted their inhaler regimen as appropriate.
The following results were accomplished over 10 months (September 2025 – June 2026). Overall, carbon emissions from inhalers in our family practice were reduced by 70%. Per month, 74kg of CO2 equivalent (kgCO2e) was saved; this is equivalent to 360km driven in a gas-powered car, or 3 propane cylinders for home BBQ each month! Additionally, patients who met with the pharmacist indicated that they received valuable and patient-centred care, and that they recognized the importance of the connection between their medication and the environment.
This project reinforced our belief that family physicians play a critical role in addressing the climate crisis. We learned that EMR automated tools were easy to implement and did not disrupt workflow, and that team-based care improves health system efficiency and supports patient-centred care. Finally, patients are open to considering the environmental impact of their medications.
Questions or interested in learning more about implementing similar changes in your family practice? Please contact:
Dr. Nicola Tam
Morgan Flynn