NHS net zero ambitions advanced by MHRA approval of first low-carbon pMDI COPD inhaler

As part of Net Zero Awareness Week (5–11 July), Health Innovation East is highlighting the significance of the recent approval by the Medicines and Healthcare products Regulatory Agency (MHRA) of the world’s first low-carbon version of Trixeo Aerosphere – a pressurised Metered-Dose Inhaler (pMDI) for chronic obstructive pulmonary disease (COPD) inhaler. Approved in May this year, this development marks an important step towards achieving the NHS’s ambitious net zero commitments.

COPD affects approximately 1.2 million people in the UK and is the second most common cause of emergency hospital admissions. (1) Inhalers, essential for managing COPD symptoms such as shortness of breath and wheezing, have historically posed environmental challenges due to the high global warming potential (GWP) of their propellants. (2)

The MHRA-approved Trixeo Aerosphere inhaler introduces a new propellant, HFO-1234ze(E), with a near-zero GWP, offering a 99.9% reduction compared to existing inhalers. Critically, the inhaler retains the same effectiveness, safety profile, dosing regimen and cost as the original formulation. (3)

The NHS’s “Delivering a Net Zero National Health Service” plan commits to net zero by 2040 for emissions it directly controls, and by 2045 for those it influences. It outlines ambitions to achieve an 80% emissions reduction by 2028–2032 for directly controlled emissions, and by 2036–2039 for those it influences. (4) With inhalers contributing approximately 3% of the total NHS carbon footprint, innovations such as the low-carbon Trixeo inhaler directly support these goals.

The recently published NHS ten-year plan reinforces these net zero ambitions, stating:

“We will prioritise the NHS’ existing commitments set out in Delivering a Net Zero Health Service – including achieving net zero by 2040 for the emissions the NHS controls and by 2045 for the emissions it can influence. All NHS bodies will be expected to decarbonise, reduce environmental impact and increase resilience to climate risks in line with the climate change duties set out in the Health and Care Act 2022.” (5)

Integrated Care Systems (ICSs) in the East of England, including Bedfordshire, Luton and Milton Keynes (BLMK), are currently updating their Green Plans to embed sustainability and decarbonisation into healthcare delivery. The draft BLMK Green Plan commits ICS partners to adopting the Sustainable Value equation, Sustainable Healthcare model, and environmental impact assessments from April 2026. It highlights a long-term perspective on investments and greater collaboration, stating:

“The ICB will work with voluntary, community and social enterprises (VCSEs), research institutions, and innovators to identify key sustainability challenges, identify funding opportunities, and develop a pipeline of innovations and more sustainable care pathways to apply in BLMK.” (6)

As all ICSs across the East of England prepare to publish their renewed Green Plans this year, low-carbon pMDI inhalers are an example of actionable, evidence-based innovations ready for widespread adoption. It offers significant potential for carbon savings while maintaining high-quality patient care.

Health Innovation East plays a key role in supporting NHS organisations and innovators navigating the transition to net zero healthcare. Our Environmental Sustainability Toolkit provides essential guidance on aligning innovations with NHS net zero targets, particularly highlighting key opportunities such as decarbonising medicines and medical devices. (7) Our specialist consultancy team offers comprehensive support in evaluating, implementing, and scaling sustainable healthcare innovations.