Every Breath Counts: Toward Sustainable Respiratory Care

Today, rising temperatures, worsening air quality, and increasingly frequent extreme weather events are no longer distant threats: they are daily realities, especially for people living with respiratory conditions like asthma or chronic obstructive pulmonary disease (COPD).

The climate crisis is a health crisis

In 2024, the world surpassed the 1.5°C temperature increase once projected for 2050. Even small shifts in temperature or humidity can alter mortality rates for vulnerable populations, and outdoor air pollution alone causes 4.2 million premature deaths each year.

So, the question is no longer if we need to act — but how fast we can

It’s time to rethink how we deliver care. Clinical innovation is essential, but sustainability is also critical for patient well-being and long-term health system resilience. After all, healthcare systems are responsible for up to 5% of global greenhouse gas emissions. That’s why healthcare professionals, policymakers, and the pharmaceutical industry must work together to deliver concrete solutions to benefit both patients and the planet.

Consider this: what if the medicine that helps you breathe may also contribute to rising temperatures that make it harder to breathe? 

Respiratory inhalers are a case in point: they’re essential for millions of patients, yet their climate impact is frequently overlooked. In fact, today, pressurized metered dose inhalers (pMDIs) used currently contain propellants with high global warming potential and while these products can be lifesaving, they also contribute to healthcare carbon emissions.

This raises a critical question: how do we ensure patients get the treatments they need without confronting them with the choice between their health and the planet’s?

The answer lies in innovation that’s both patient-centered and planet-conscious

Developing carbon minimal pMDIs is one such step. With the usage of next-generation propellants, these inhalers will ensure treatment continuity providing products with the same active ingredients, efficacy, safety and patient usability, but with a lower carbon footprint.

But innovation alone isn’t enough. To reduce the climate impact of inhalers, we need a broader shift: achieving accurate and early diagnosis of asthma and COPD, improving patient education and inhaler technique, and fostering sustainable treatment habits. This includes reducing over-reliance on short-acting beta-agonist (SABA) inhalers—which can contribute to both higher greenhouse gas emissions and poorer disease control—and encouraging adherence to maintenance therapies that improve long-term outcomes.

This is how we move from intention to impact: by embedding sustainability into every layer of respiratory care

As the link between climate and health becomes clearer, governments and international bodies are stepping in to accelerate change and implement regulations, essential tools for safeguarding public health.

The Kigali Amendment, signed in 2016, aims to phase down hydrofluorocarbons (HFCs) (including hydrofluoroalkanes (HFAs))—potent greenhouse gases—prompting scrutiny of their use in pMDIs. 

The EU's 2024 Fluorinated Greenhouse Gases Regulation includes pharmaceutical HFCs under a quota system, with safeguards to ensure supply and allow time for transition. 

In the United States, the American Innovation and Manufacturing Act (2020) gave the Environmental Protection Agency (EPA) the authority to reduce HFCs, targeting a 15% cap on production and use by 2036. This includes allowances for essential uses like inhaler propellants, but the message is clear: the clock is ticking.

A complete phase-out of HFCs is foreseen by 2050. Likewise, national healthcare systems (HCS) have started decarbonizing, and inhalers are a key focus. Decarbonization policies include updated clinical guidelines, greener procurement policies, and growing patient awareness—all supporting a shift to low-carbon inhaler options.

But why wait for regulation to act?

Real climate leadership in pharma means anticipating change, not reacting to it. It means embedding sustainability into product development, supply chains, and patient engagement strategies. It means recognizing that innovation is not just about new molecules, it’s about new models of care that are resilient, equitable, and low-carbon.

At Chiesi, we believe patients shouldn’t have to choose between their health and the planet’s

Our transition to a carbon minimal pMDI portfolio reflects our commitment to shared value: where innovation drives not only business growth, but also patient health, community well-being, and environmental sustainability.

To protect both patients and the planet, Chiesi has invested more than €350M to reduce the climate impact of its pMDI products. A non-persistent, next-generation propellant, HFA 152a, has been adopted to replace the current high-global warming potential propellant, HFA 134a, reducing pMDIs’ carbon footprint by up to 90%, in the same range as dry powder inhalers (DPIs).

But this is more than a product upgrade: it’s a systemic shift. To reinforce supply security and European resilience, Chiesi is also investing €430 million in a new manufacturing site in Nerviano (Milan), set to open by 2030. This facility will produce carbon minimal inhalers (next generation propellant pMDIs and DPIs), and sterile biological products through a fully European-based supply chain.

We now have the knowledge, the technology, and the momentum to transform respiratory care into a model of sustainability. What’s needed now is a collective will. When healthcare professionals, policymakers, industry leaders, and patients come together with a shared purpose, we can build a future where health and sustainability go hand in hand.

So let’s answer the question of when we need to act with a powerful, collective now.

Because every breath counts and every “yes” to change helps to protect it.