Climate Conscious
Inhaler Prescribing

September 2022 – March 2023

Join primary care teams from across Canada in the Climate Conscious Inhaler Prescribing Collaborative!

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Why do we need climate conscious inhaler prescribing?

Did you know that the most widely-prescribed metered-dose inhalers (MDIs) have a sizable carbon footprint? One hundred doses of a salbutamol inhaler is equivalent to driving 290 km!

These emissions can be minimized in ways that go hand-in-hand with improving patient care and outcomes:

  • PRESCRIBE APPROPRIATELY: Reducing objectively unnecessary inhaler prescribing will reduce the environmental impact associated with inhaler use
  • SWITCH: There are some patients for whom more sustainable alternatives may be appropriate and preferred
  • TEACH: Regardless of inhaler type, there is often room to improve inhaler technique, thereby reducing emissions and waste
  • DISPOSE: Many inhalers end up in the regular waste stream, but there are opportunities for more sustainable disposal in some jurisdictions
Did you know that 100 doses of an inhaler like this [image of a metered dose inhaler] are equivalent to a 290 km care journey?

Interested in learning more about the Collaborative, including how to put together a team?

What is the CASCADES Climate Conscious Inhaler Prescribing Collaborative?

This fall, CASCADES will be running the Climate Conscious Inhaler Prescribing Collaborative – a learning opportunity based on an established spread model for Quality Improvement innovation. This 3 credits-per-hour Group Learning program has been certified by the College of Family Physicians for up to 33 Mainpro+ credits.

Through three learning sessions (between September 2022 and March 2023) and regular check-ins, participating teams from primary care settings across Canada will receive access to and training on a number of tools that can be used to facilitate prescribing appropriately, switching, teaching technique, and proper disposal.

Teams will learn from providers who have successfully implemented these tools, receive support from CASCADES as they test and adapt the tools, and generate collective knowledge on how best to further refine and spread the tools.

The Collaborative is open to teams who are new to climate conscious inhaler prescribing as well as groups who are already working on improving inhaler sustainability.

Participation Logistics

The learning sessions will be two hours in length, and will take place in September 2022, December 2022, and March 2023, with regular check-ins between sessions to ensure teams have the support they need and can learn from each other. Selected teams will be given some short prework to complete in advance of the first learning session.

Learning session dates:

  • Learning Session 1: Friday, Sept 30, 2022, 1:00 – 3:00 ET
  • Learning Session 2: Friday, December 9, 2022, 1:00 – 3:00 ET
  • Learning Session 3: Friday, March 10, 2023, 1:00 – 3:00 ET

The learning sessions will be supported by the following faculty:

  • Dr. Kimberly Wintemute, Family Physician (ON)
  • Dr. Alan Kaplan, Family Physician (ON), Chair of Family Physician Airways Group of Canada

Eligibility Criteria

Teams MUST be:

  • From or involved with a primary care setting
  • Able to commit to having some team members attend all three learning sessions
  • Willing to share their implementation journey with the collaborative and the broader healthcare community

Teams will IDEALLY:

  • Be multidisciplinary (possible team members include, but are not limited to: prescribers, respiratory therapists, nurses, pharmacists, IT staff, managers, QI staff, patient-partners)
  • Have embedded QI and measurement capacity
  • Have organizational support (if applicable)


Applications will be considered on a rolling basis..

*Individuals able to implement and track changes on their own are also welcome

Sustainable Inhaler Community of Practice

Those with interest in sustainable inhalers who are unable to commit to the Collaborative are invited to join the Sustainable Inhalers Community of Practice. Members of the community of practice will receive updates on the spread effort and be invited to participate in various ways throughout the life of the collaborative, including by: 

  • Sharing tools
  • Offering jurisdiction-specific guidance
  • Sharing updates with their network

Join the Sustainable Inhalers Community of Practice here.


CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis) is a multi-year capacity-building initiative to address healthcare’s contribution to the climate crisis. The project is led by the University of Toronto’s Centre for Sustainable Health Systems in partnership with the Healthy Populations Institute at Dalhousie University, the Planetary Healthcare Lab at the University of British Columbia, and the Canadian Coalition for Green Health Care. It is funded for a five-year term by Environment and Climate Change Canada’s Climate Action and Awareness Fund for Community-Based Climate Action Projects.

Info Session

Info Session FAQ

Is there a cost to participate in the collaborative? 

No, participation in the learning collaborative is free! 

Will all the resources be available in French? 

Yes, all the resources are being translated into French, both patient- and provider-facing. Our learning sessions will be conducted in English. If you require/prefer French translation during the learning sessions, please contact Nicole Simms at [email protected] to discuss arrangements. 

Do I have to be a physician to participate in the learning collaborative?

No, you can participate if you are involved in the support or delivery of primary care. This includes nurse practitioners, respiratory therapists, nurses, pharmacists, IT staff, managers, QI staff, and patient-partners. Teams that are multidisciplinary benefit from having various insights into the care pathway of patients being prescribed inhalers. 

I practice in a hospital-based care setting. Can I still participate in the learning collaborative? 

Our learning collaborative and resources are targeted towards primary care, so currently being in a primary care setting is one of the requirements to participate. If you work in collaboration with a hospital-affiliated primary care team, we encourage you to join with members of that setting. If not, you can still start a sustainable inhaler initiative in your care setting, which CASCADES staff can help support with the resources on our website. We are in the process of developing a change package aimed at acute care settings and will provide updates as it progresses. 

Is there a specific goal of prescribing change we need to achieve? 

During the first learning session, each team will set their own goals for practice changes that are suitable to their care settings. We will provide an outline for how to develop these goals and your team is encouraged to collect baseline data to aid in this process. 

Can I get credits or compensation for participating?

This 3 credits-per-hour Group Learning program has been certified by the College of Family Physicians for up to 33 Mainpro+ credits. CMQ accepts the hours of participation in the program as a recognized professional development activity. Pharmacists in British Columbia, Manitoba, Saskatchewan, Newfoundland and Labrador, and PEI can claim hours of participation in the program as accredited continuing education units (CEUs). A certificate of completion will be provided at the end of the Learning Collaborative, and can be used to self-report hours of participation.

I/our team already has an initiative related to sustainable inhalers. Can I/we still participate, or do we need to pause our current project? 

Teams already engaging in sustainable inhaler initiatives are encouraged to join as well! We encourage that you build on your existing plans with the resources from CASCADES and we can support the creation/modification of new tools or strategies.  

I noticed that one of the recommendations is to consider switching from SABA to bud/form (Symbicort). That is expensive/not covered in my province. How has this been addressed? 

During the initiative based in Toronto, the working group met with the Ontario Drug Benefit team to discuss the removal of limited use (LU) codes on Symbicort to align the formulary with updated clinical guidelines. Additionally, we have also had multiple discussions with CADTH – the Canadian Agency for Drugs and Technologies in Health about the coverage of Symbicort and other dry-powder inhalers. We are keen to explore ways for the national spread initiative to inform policy development nationally in Canada. 

Is this learning collaborative funded by any pharmaceutical companies? 

The Climate Conscious Inhaler Prescribing Learning Collaborative is run by CASCADES, which is an initiative undertaken with the financial support of the Government of Canada through Environment and Climate Change Canada’s Climate Action and Awareness Fund for Community-Based Climate Action Projects. We have no relationships with any pharmaceutical companies or any other financial sponsors.  

Sustainable Inhaler National Advisory Commitee Members:

  • Dr. Samantha Green (CHAIR), Family Physician, Assistant Professor, and Co-Lead in Climate Change and Health, Department of Family and Community Medicine, University of Toronto
  • Dr. Kimberly Wintemute, Family Physician (ON)
  • Dr. Meghan Davis, Family Physician (ON)
  • Dr. Jean-Phillipe Michel, Family Physician (QC)
  • Dr. Ann Loewen, Family and Emergency Physician (MB)
  • Helen Boyd, Nurse Practitioner (BC)
  • Dr. Valeria Stoynova, General Internist (BC)
  • Celia Culley, Clinical Pharmacy Coordinator (BC)
  • Dr. Celina Dharamshi, Resident (AB)
  • Dr. Sonja Wicklum, Family Medicine Clerkship Director (AB)
  • Dr. Myriam Gagné, Postdoctoral Research Fellow (ON)
  • Dr. Samuel Campbell, Research Director, Emergency Medicine Clinical Chief (NS)
  • Kent Cadogan Loftsgard, Patient partner (BC)
  • Debra Hartmann, Patient partner (ON)