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Nelson doctors working to reduce metered dose inhaler usage for planetary health

Doctors want patients to consider switching to dry powder inhalers
Dr. Lee MacKay is a family physician and medical director of the diabetes clinic at Kootenay Lake Hospital. Photo: Tyler Harper

Submitted by Kootenay Lake Hospital Facility Engagement Initiative

The Engaging in Climate Change Action at Kootenay Lake Hospital Working Group recently launched a campaign to raise awareness about the planetary effects of metered dose inhalers (MDIs) to reduce our climate impact in the Kootenay region. The group hopes that patients who are normally prescribed an MDI will switch to a dry powder inhaler (DPI) or the newer Respimat devices, which are less harmful to the environment.

Last fall, working group member Dr. Lee MacKay attended a series of professional development courses through CASCADES, a multi-year capacity-building initiative to address health care’s contribution to the climate crisis in Canada. Through these courses, MacKay was struck by information presented about the harmful effects of MDIs in relation to climate change.

“I thought the effects of MDIs were minimal, until I saw that they are responsible for 2.4 to 4.5 per cent of the total climate change impact of the National Health Service in the United Kingdom,” he said. “To put this in perspective, each MDI device has an equivalent impact to driving 290 kilometres in a gasoline vehicle.”

In many jurisdictions, DPIs are prescribed to about 70 per cent of patients with asthma or other respiratory illnesses like chronic obstructive pulmonary disease. In Canada, however, MDIs are still predominantly prescribed. As MacKay points out, this is often clinically unnecessary.

“Most patients can safely make the switch to a dry powder inhaler, unless they are among patients in the bottom 10 per cent of inspiratory flow,” he explained. “In my practice, each of my patients requiring a puffer has made the change over satisfactorily except one patient with severe COPD.”

In addition, MacKay also met with respiratory therapist Mitch Wilkey and clinical pharmacist Liz Edwards to discuss options to reduce MDI prescriptions and usage at Kootenay Lake Hospital. A general agreement has been reached to encourage stocking a greater DPI-to-MDI ratio of inhalers and to also suggest that patients consider choosing a DPI when appropriate.

Patients who would like to make the switch can request a DPI prescription from their family physician or ask their pharmacist to provide a DPI instead of an MDI. For more information about the effects of MDIs, please visit Choosing Wisely Canada at

Dr. Lee MacKay is a family physician and medical director of the diabetes clinic at Kootenay Lake Hospital. MacKay is also a proud member of Doctors and Nurses for Planetary Health Kootenay Boundary and co-leads the Engaging in Climate Change Action at KLH Working Group with his colleague, Dr. Kyle Merritt.