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Peer-reviewedCC BY-NC 4.0The Journal of Climate Change and Health

Canadian healthcare professionals’ attitudes towards climate change and the environmental impact of inhalers

  • Stacey J Butler1
  • Geneviève C Digby2
  • Caitlin Roy3
  • Sze Man Tse4
  • Shellyza Sajwani5
  • Jill Hubick6
  • Carolyn McCoy7
  • Ivy Lam8
  • Alexander Singer9
  • Alan Kaplan10
  • Eva Leek1
  • Sakina Walji11
3 more authors
  • Valeria Stoynova12
  • Erika Penz13
  • Samir Gupta14
14 affiliations
  1. 1Division of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
  2. 2Division of Respirology and Sleep Medicine, Queen’s University, Kingston, Ontario, Canada
  3. 3Canadian Association of Pharmacy for the Environment, Regina, Saskatchewan, Canada
  4. 4Division of Respiratory Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
  5. 5Canadian Association of Pharmacy for the Environment, Ottawa, Ontario, Canada
  6. 6Lung Saskatchewan, Saskatoon, Saskatchewan, Canada
  7. 7Canadian Society of Respiratory Therapists, Ottawa, Ontario, Canada
  8. 8Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
  9. 9Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  10. 10Family Physicians Airways Group of Canada, Aurora, Ontario, Canada
  11. 11Sinai Health System, Toronto, Ontario, Canada
  12. 12Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  13. 13College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  14. 14Division of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Corresponding author at: Respirologist & Clinician-Scientist, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
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Abstract

Introduction: Preferential prescribing of inhalers with low carbon footprints over metered-dose inhalers (MDIs) can reduce healthcare’s climate impact. We aimed to assess healthcare professionals’ (HCPs) attitudes towards climate change, its health impacts, and inhaler prescribing practices. Methods: We invited HCPs via professional societies and non-profit organizations to complete an online survey (November 2024-March 2025). Multivariable regression examined associations between sociodemographic characteristics and climate change risk perception index (CCRPI) scores, inhaler carbon footprint awareness, and prescribing behaviors. Results: In total, 430 HCPs responded (median age: 41 years (IQR: 34–50); 74% women; 94% completion rate). Climate change concern was high [median CCRPI score 34/40 (IQR: 30–37)]. Most respondents (85%) were aware of inhaler carbon footprint variability. Nurses and nurse practitioners were less likely than physicians to be aware of this variability (OR: 0.29, 95% CI: 0.11–0.75). Only 49% of prescribers preferentially prescribed low carbon devices to new inhaler users and just 17% routinely switched current MDI users. Higher CCRPI scores were associated with greater awareness of inhaler carbon footprint variability (OR: 1.34, 95% CI: 1.04–1.72) and preferential prescribing of low carbon devices for new inhaler users (OR: 1.70, 95% CI: 1.32–2.23) and current MDI users (OR: 1.30, 95% CI: 1.03–1.68). Carbon footprint ranked 8th (IQR: 7–10) among 12 attributes influencing device selection. Conclusion: Despite significant concern for climate change and awareness of inhaler-related carbon emissions, preferential prescribing of low carbon inhalers is not part of routine practice. Targeted interventions are needed to support climate-conscious prescribing and reduce inhaler carbon emissions.

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Cite

BibTeXRIS
BibTeX
@article{butler2026canadian,
  title = {{Canadian healthcare professionals’ attitudes towards climate change and the environmental impact of inhalers}},
  author = {Stacey J Butler and Geneviève C Digby and Caitlin Roy and Sze Man Tse and Shellyza Sajwani and Jill Hubick and Carolyn McCoy and Ivy Lam and Alexander Singer and Alan Kaplan and Eva Leek and Sakina Walji and Valeria Stoynova and Erika Penz and Samir Gupta},
  journal = {The Journal of Climate Change and Health},
  year = {2026},
  month = oct,
  doi = {10.1016/j.joclim.2026.100761},
  url = {https://doi.org/10.1016/j.joclim.2026.100761},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Canadian healthcare professionals’ attitudes towards climate change and the environmental impact of inhalers
AU  - Stacey J Butler
AU  - Geneviève C Digby
AU  - Caitlin Roy
AU  - Sze Man Tse
AU  - Shellyza Sajwani
AU  - Jill Hubick
AU  - Carolyn McCoy
AU  - Ivy Lam
AU  - Alexander Singer
AU  - Alan Kaplan
AU  - Eva Leek
AU  - Sakina Walji
AU  - Valeria Stoynova
AU  - Erika Penz
AU  - Samir Gupta
PY  - 2026
DA  - 2026/10/24
JO  - The Journal of Climate Change and Health
DO  - 10.1016/j.joclim.2026.100761
UR  - https://doi.org/10.1016/j.joclim.2026.100761
AB  - Introduction: Preferential prescribing of inhalers with low carbon footprints over metered-dose inhalers (MDIs) can reduce healthcare’s climate impact. We aimed to assess healthcare professionals’ (HCPs) attitudes towards climate change, its health impacts, and inhaler prescribing practices. Methods: We invited HCPs via professional societies and non-profit organizations to complete an online survey (November 2024-March 2025). Multivariable regression examined associations between sociodemographic characteristics and climate change risk perception index (CCRPI) scores, inhaler carbon footprint awareness, and prescribing behaviors. Results: In total, 430 HCPs responded (median age: 41 years (IQR: 34–50); 74% women; 94% completion rate). Climate change concern was high [median CCRPI score 34/40 (IQR: 30–37)]. Most respondents (85%) were aware of inhaler carbon footprint variability. Nurses and nurse practitioners were less likely than physicians to be aware of this variability (OR: 0.29, 95% CI: 0.11–0.75). Only 49% of prescribers preferentially prescribed low carbon devices to new inhaler users and just 17% routinely switched current MDI users. Higher CCRPI scores were associated with greater awareness of inhaler carbon footprint variability (OR: 1.34, 95% CI: 1.04–1.72) and preferential prescribing of low carbon devices for new inhaler users (OR: 1.70, 95% CI: 1.32–2.23) and current MDI users (OR: 1.30, 95% CI: 1.03–1.68). Carbon footprint ranked 8th (IQR: 7–10) among 12 attributes influencing device selection. Conclusion: Despite significant concern for climate change and awareness of inhaler-related carbon emissions, preferential prescribing of low carbon inhalers is not part of routine practice. Targeted interventions are needed to support climate-conscious prescribing and reduce inhaler carbon emissions.
SN  - 2667-2782
ER  -