Abstract
BACKGROUND: The environmental impact of inhalers, particularly pressurised metered dose inhalers with high global warming potential, poses significant challenges in the context of planetary health. Although dry powder inhalers (DPIs) offer a more sustainable alternative, entrenched prescribing practices prevail. This systematic review evaluates patient and physician perspectives on inhaler environmental impacts and examines barriers and opportunities for leadership in adopting sustainable practices. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was performed from inception to 12 June 2024, across Medline via EBSCO, EMBASE via Elsevier and Web of Science. Four studies were included, surveying 433 participants. Data extraction and risk-of-bias assessment were conducted using a standardised form and the Newcastle-Ottawa Scale. RESULTS: Findings indicate that while both patients and providers express environmental concerns, limited awareness and entrenched clinical practices hamper the transition to DPIs. Leadership insights reveal that a fragmented sense of responsibility, insufficient training and low confidence in discussing environmental impacts are significant barriers. However, targeted education and interprofessional collaboration have been shown to increase the willingness to adopt sustainable inhaler practices. CONCLUSIONS: The results underscore the need for leadership in healthcare to champion sustainable prescribing. Empowering clinicians through education, clear clinical guidelines and eco-ethical leadership initiatives is essential. Health leaders have the opportunity to transform practice by integrating environmental considerations into routine care, ultimately advancing planetary health. THE PROSPERO REGISTRATION NUMBER: CRD42024552555.