Protecting continuity of care through sustainable respiratory solutions

Healthcare in Europe is at a critical and pivotal moment in its sustainability journey, with growing recognition of both its environmental impact and its role in advancing patient care.

As health systems seek to balance innovation with the need to address sustainability, increasing attention is being paid to how care can be delivered in ways that maintain continuity for patients while also being environmentally responsible. Although the ambition to transition towards more sustainable healthcare has been longstanding, the sector still accounts for more than 4% of global greenhouse gas emissions across the value chain.¹

Respiratory innovation at the intersection of sustainability and patient care

Within this broader carbon footprint, inhalers, and particularly pressurised metered-dose inhalers (pMDIs), which currently rely on high global warming potential propellants, represent a notable source of carbon emissions, despite being key devices for millions of patients and fundamental to the management of respiratory diseases.

This is particularly significant given that chronic respiratory diseases remain among the leading causes of death and hospitalisation across Europe, claiming nearly 400,000 lives annually.² Globally, fewer than half of asthma patients achieve good disease control and, while there are lower-carbon-emitting inhaler options that do not contain a propellant, including dry powder inhalers (DPIs), many patients cannot generate the inspiratory effort required to use these devices effectively or they exhibit greater confidence and proficiency when using a pMDI.^3,4

As a result, pMDIs account for over 60% of inhaler use and approximately 70% of inhaler-related emissions.^5,6,7 Yet, pMDIs remain indispensable for many patients, including children, older adults, people experiencing exacerbations, and those with limited inspiratory flow.^5,8,9

This creates a fundamental tension for healthcare systems: how can they maintain continuity of care while progressing toward greater sustainability? How can efficacy, safety, quality, and usability be preserved when one of the most widely prescribed treatment options also accounts for a substantial share of inhaler-related emissions?

Advancing sustainability with patients at the heart of care

At Chiesi, addressing this challenge required deliberate choices to make meaningful progress. That's why we have invested more than €400 million since 2019 to transition our pMDI products to a next-generation propellant, one of the most impactful actions in our roadmap to advance the company’s commitment to achieving Net Zero by 2035.¹⁰

This funding laid the groundwork for our Carbon Minimal Inhaler Platform that transitions six of our pMDI formulations to use a hydrofluoroalkane (HFA) 152a propellant, which has low-global warming potential and is non-PFAS*. This advancement is expected to deliver up to a 90% reduction in carbon emissions compared to our current products and within the same range as those associated with use of DPI devices.^11,12 At the same time, it aims at maintaining the same efficacy, safety, device usability, and taste, ensuring therapeutic consistency and continuity of care.^13,14

Importantly, this advancement is designed to ensure patients can continue with their same device and technique, delivering comparable efficacy whilst significantly reducing environmental impact. Beyond patient care continuity, HFA-152a propellant provides a practical pathway to advance the Fit for 55 objectives, including Europe’s goal of achieving climate neutrality by 2050, further underscoring that innovation and sustainability can be in line with the European Union's climate objectives. This is a clear example of sustainability achieved through innovation, not restriction.

Innovation without disrupting patient care

For many people living with asthma and chronic obstructive pulmonary disease (COPD), pMDIs remain the most appropriate and reliable option. So, as healthcare systems accelerate efforts to reduce carbon emissions, we must all remember that choosing the most suitable respiratory treatment is a complex decision between medical professionals and patients. No single device suits all patients. Clinical need and continuity of care must therefore guide decisions about inhaler choice.

For clinicians, this supports the priority to ensure that patients maintain stable, evidence-based treatment while new, Carbon Minimal pMDI options become available.

That's why we chose HFA-152a propellant, allowing us to reformulate inhaled medications that perform comparably to today’s inhalers so that clinicians can protect patient outcomes and support treatment stability as respiratory treatment becomes more sustainable. For patients, it means they can rely on their same treatment without adding to the system's carbon emissions.

Driving meaningful change for sustainable healthcare

While we are proud of our work on the Carbon Minimal Inhaler platform, we recognise that reducing the healthcare system's carbon footprint requires collective action. Meaningful change will only be possible if sustainability is aligned with patient safety, quality of care, and continuous access to treatments and relies on a shared commitment from all stakeholders in the healthcare sector and respiratory community.

At Chiesi, our commitment is embedded into the very core of our work.

In 2025, we were certified as a B Corp for the third time, reflecting a strong commitment to continuous improvement across environmental, social, and governance practices throughout the organisation. Our progress was achieved through more than 500 improvement initiatives across over 30 countries and a six-month audit.¹⁵

Since 2018, Chiesi has adopted the legal form of a Benefit Corporation in the United States and Italy, followed by France in 2021 and Colombia in 2024, implementing governance models in all countries where the company operates to embed sustainability across our organisation. This commitment, strengthened by our strategic plans and ambitions – including the goal of reaching Net Zero greenhouse gas emissions by 2035 – reinforces our accountability to high standards of transparency, social and environmental responsibility, and sustainable growth.¹⁶

Sustainability must be comprehensive, encompassing governance, culture, innovation, and scientific development, but it also should be in the fabric of our companies, in the way we approach work. Our ambition and achievements to date position Chiesi as a leader in the healthcare industry’s decarbonisation journey.

To us, transitioning our pMDI products to the next generation propellant HFA-152a is one of the most immediate and effective ways to decarbonise respiratory care while maintaining clinical efficacy and patient continuity. But we cannot do it alone, and product innovation is not sufficient to make healthcare systems as a whole more sustainable.

Our call for collective, comprehensive action

At Chiesi, we are committed to working with the respiratory community to integrate Carbon Minimal pMDIs in a way that is seamless for patients and clinicians. In doing so, we can make carbon-minimal respiratory care the norm – so patients don’t have to change what works for them.

We are also here to support our industry peers in embedding sustainability into the way they work by sharing best practices. We know that collective action requires partnership and we're here to move forward together.

We believe in innovation that improves the health outcomes of people living with respiratory conditions, and that is essential to achieving sustainable and resilient healthcare systems across Europe. But we cannot achieve meaningful change without leveraging innovative thinking and working collaboratively. We stand ready to work alongside EU institutions, Member States, and the wider healthcare community to enable this transition to Carbon Minimal pMDIs containing next-generation propellant developed and manufactured in Europe.

_{* per- and polyfluoroalkyl substances (PFAS) – non-PFAS means also non-forever chemical.}
 

About the author

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Carmen Dell’Anna is Senior Vice President Global Medical Affairs & Franchise Air Strategy at Chiesi. Dell’Anna is a physician and medical affairs executive with more than two decades of global experience in the pharmaceutical industry. Drawing on her background in clinical practice and extensive international work across diverse therapeutic areas – including chronic respiratory diseases, critical care, neonatology, and cystic fibrosis – she has championed approaches that integrate evidence‑based scientific excellence, patient‑centred outcomes, and collaborative partnerships across the health ecosystem.

About Chiesi Group

Chiesi is a research-oriented international biopharmaceutical group that develops and markets innovative therapeutic solutions in respiratory health, rare diseases, and specialty care. The company’s mission is to improve people’s quality of life and act responsibly towards both the community and the environment.

By adopting the legal form of Benefit Corporation in Italy, the US, France and Colombia, Chiesi’s commitment to creating shared value for society as a whole is legally binding and central to company-wide decision-making. As a certified B Corp since 2019, Chiesi is part of a global community of businesses that meet high standards of social and environmental impact. The company aims to reach Net-Zero greenhouse gases (GHG) emissions by 2035.

With 90 years of experience, Chiesi is headquartered in Parma (Italy), with 31 affiliates worldwide, and counts more than 7,500 employees. The Group’s research and development center in Parma works alongside 6 other important R&D hubs in France, the US, Canada, China, the UK, and Sweden.