The Moral Injury of Inhaler Prescribing

This perspective article explores the ethical dilemma physicians face when prescribing inhalers in the United States. While inhalers like metered-dose versions are vital for asthma and COPD treatment, they often contain hydrofluoroalkanes (HFAs), which contribute significantly to greenhouse gas emissions. Alternatives such as dry-powder or soft-mist inhalers offer lower environmental impact but face barriers related to insurance formularies, cost, and limited availability in the U.S. The authors also critique pharmaceutical monopolies, industry ties to tobacco companies, and regulatory gaps that hinder access to affordable, sustainable inhalers. They argue for policy reforms to incentivize development and coverage of low-carbon inhalers and to realign medical prescribing with environmental responsibility easing the moral burden on physicians and improving patient care.

This perspective article explores the ethical dilemma physicians face when prescribing inhalers in the United States. While inhalers like metered-dose versions are vital for asthma and COPD treatment, they often contain hydrofluoroalkanes (HFAs), which contribute significantly to greenhouse gas emissions. Alternatives such as dry-powder or soft-mist inhalers offer lower environmental impact but face barriers related to insurance formularies, cost, and limited availability in the U.S. The authors also critique pharmaceutical monopolies, industry ties to tobacco companies, and regulatory gaps that hinder access to affordable, sustainable inhalers. They argue for policy reforms to incentivize development and coverage of low-carbon inhalers and to realign medical prescribing with environmental responsibility easing the moral burden on physicians and improving patient care.