Decarbonising respiratory care requires a new kind of generics innovation
Generics manufacturers have long played a critical role in supporting the sustainability of the NHS, delivering affordable medicines at scale, expanding patient access, and helping healthcare systems manage increasing demand under growing financial pressure.
But as the NHS accelerates towards its Net Zero ambitions, the definition of sustainability is evolving. Increasingly, the challenge is not only how medicines are delivered affordably, but how they can also reduce environmental impact without compromising patient care. Respiratory care has become one of the clearest examples of this challenge in practice.
Inhalers account for approximately 3% of the NHS carbon footprint, with propellant-containing pressurised metered-dose inhalers (pMDIs) being the more commonly prescribed inhaler type, despite having a much higher carbon footprint than dry powder inhalers (DPIs).[1] At the same time, pMDIs remain clinically essential for many patients, including some children, older people, and those experiencing acute exacerbations of asthma or COPD.
As the NHS works towards its target of reducing inhaler-related emissions by 50% by 2030,[2] the focus is increasingly shifting from whether the transition should happen, to how it can be achieved responsibly.
The challenge of delivering lower-carbon respiratory care
While dry powder inhalers (DPIs) may be an appropriate lower-carbon option for some patients, they are not clinically suitable for everyone. Sustainable respiratory care requires balancing environmental ambition with clinical reality, patient outcomes, continuity of care, and long-term supply resilience. This is particularly important in acute and complex settings, where some patients may struggle to achieve the inspiratory flow needed for effective DPI use. For these patients, pMDIs remain a clinically important treatment option.
Increasingly, respiratory clinicians are advocating for a more individualised approach to sustainable care, recognising that optimising patient outcomes and reducing environmental impact must go hand in hand. The European Respiratory Society has previously highlighted the concept of the ‘green patient’, where inhaler choice, technique, use of a spacer, patient behaviours, management of exacerbations, and efficient use of medicines are all considered as part of a more sustainable respiratory pathway.[3] These clinicians observed, the greenest inhaler is ultimately the one the patient can use effectively to protect and improve their health without the fear and stigmatism of their carbon footprint.
Why low-carbon inhalers demand a new kind of innovation
Delivering lower-carbon respiratory medicines requires a level of scientific and regulatory innovation not traditionally associated with the generics industry. Historically, much of the generics sector has been built around replication, efficiency, and scale. But developing next-generation low-carbon propellants is fundamentally different. It requires advanced formulation science, complex regulatory expertise, and significant long-term investment in respiratory innovation.
As a result, lower-carbon respiratory medicines are challenging traditional assumptions about the role of generics manufacturers. The ones leading this shift will be those able to operate successfully in more complex, less commoditised areas of medicine, combining affordability with scientific depth and innovation.
The move toward lower-carbon inhalers also raises important questions around affordability, supply, and long-term access. Lower-global-warming-potential propellants are expected to be more expensive than existing alternatives, particularly given the R&D and manufacturing investment needed to develop future pMDIs.
At the same time, as the use of older propellants declines, reduced demand could affect the future availability and pricing of inhalers that continue to rely on them. The regulatory response will also be closely watched. Previous transitions away from older propellant technologies, such as chlorofluorocarbons (CFCs), ultimately led to significant market and prescribing changes once alternatives became widely available. This reinforces the need for a carefully managed transition that balances environmental progress with patient access, clinical appropriateness, and long-term supply resilience.
Balancing sustainability with patient care
The challenge for generic companies operating in respiratory medicine is not simply about reducing emissions. It is about doing so without limiting patient choice or destabilising access to essential treatments.
Sustainable respiratory care will only succeed through a combination of innovation, clinical pragmatism, and long-term collaboration across the healthcare system. That means investing in lower-carbon inhaler technologies while recognising that pMDIs will continue to play an important role for many patients. It means supporting clinically appropriate prescribing decisions that reflect individual patient needs. It also means working collaboratively with the NHS, policymakers, healthcare professionals, and industry partners to support a practical and coordinated transition.
Importantly, it also means recognising that sustainability and supply resilience are increasingly interconnected. As the industry transitions toward new propellants and technologies, maintaining reliable access to respiratory medicines will be critical. Healthcare systems cannot afford a future where environmental progress comes at the expense of continuity of care.
The future of generics will be defined by innovation
Decarbonising respiratory care will require more than new technology. It will require industry, healthcare systems, and policymakers to work together to create an environment where sustainable innovation is effective.
Traditional generics models have delivered enormous value to healthcare systems over decades. But lower-carbon medicines represent a new kind of challenge, one that depends on scientific complexity, regulatory expertise, and sustained investment in innovation. Because, ultimately, the next generation of generics will not be defined solely by cost or replication, but by the ability to combine affordability with scientific innovation, sustainable supply, and high-quality patient care at scale.
[1] NHS England. Available at: Greener NHS » Improving health outcomes for respiratory patients while reducing carbon emissions. Accessed: 29.06.26.
[2] Wilkinson AJK, Braggins R, Steinbach I, et al. Costs of switching to low global warming potential inhalers: an economic and carbon footprint analysis of NHS prescription data in England. BMJ Open. 2019;9:e028763.
[3] European Medical Journal. Available at: The Greenest Inhaler: A Patient-centric Approach - European Medical Journal. Accessed: 29.06.26
About the author
Ben Ellis is general manager UK at Lupin Healthcare, where he is responsible for leading the company's UK business and driving strategic growth. With extensive experience across the pharmaceutical sector, Ellis has a strong track record in commercial leadership, market access, and building partnerships that improve patient outcomes. He writes on the future of healthcare, access to medicines, and the role of industry in supporting a more sustainable NHS.
