{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:29:33Z","timestamp":1788740973486,"version":"build-2803163510"},"reference-count":45,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Aerosol Medicine and Pulmonary Drug Delivery"],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:p>The chlorofluorocarbons (CFCs) that were used as propellants in early pressurized metered-dose inhalers (pMDIs) had substantial ozone-depleting potential. Following the Montreal Protocol in 1987, the manufacture of a range of ozone-depleting substances, including CFCs, was gradually phased out, which required the propellants used in pMDIs to be replaced. Current pMDIs use hydrofluoroalkanes (HFAs) as propellants, such as 1,1,1,2-tetrafluoroethane (HFA-134a). Although these HFAs have no ozone-depleting potential, they have a high global warming potential (GWP), and consequently, their use is being phased down. One option for the discontinuation of HFA use in inhalers would be to discontinue all pMDIs, switching patients to dry powder inhalers (DPIs). However, a switch from pMDIs to DPIs may not be a clinically appropriate option for some patients; furthermore, the full lifecycle carbon footprint and the overall environmental impact of different inhalers should be considered. An alternative is therefore to reformulate the current HFA pMDIs to use low-GWP propellants, such as 1,1-difluoroethane (HFA-152a). This article summarizes the various steps and challenges associated with this change, illustrated using data from the inhaled triple combination of beclomethasone dipropionate, formoterol fumarate, and glycopyrronium bromide, a complex formulation of three molecules in a solution that contains liquid-phase propellant.<\/jats:p>","DOI":"10.1089\/jamp.2024.0023","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T18:30:22Z","timestamp":1730917822000},"page":"26-36","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Pharmaceutical, Clinical, and Regulatory Challenges of Reformulating Pressurized Metered-Dose Inhalers to Reduce Their Environmental Impact"],"prefix":"10.1177","volume":"38","author":[{"given":"Nicolas","family":"Roche","sequence":"first","affiliation":[{"name":"Service de Pneumologie, H\u00f4pital Cochin, APHP Centre et Universit\u00e9 Paris Cit\u00e9, Institut Cochin, INSERM UMR 1016, Paris, France."},{"name":"Inserm, \u00c9quipe d\u2019\u00c9pid\u00e9miologie Respiratoire Int\u00e9grative, CESP, Villejuif, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Usmani","sequence":"additional","affiliation":[{"name":"NHLI Imperial College London, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Franzini","sequence":"additional","affiliation":[{"name":"Chiesi Farmaceutici SpA, Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Labadini","sequence":"additional","affiliation":[{"name":"Chiesi Farmaceutici SpA, Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kusum S.","family":"Mathews","sequence":"additional","affiliation":[{"name":"Chiesi Farmaceutici SpA, Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9559-6032","authenticated-orcid":false,"given":"Sara","family":"Panigone","sequence":"additional","affiliation":[{"name":"Chiesi Farmaceutici SpA, Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job F.M.","family":"van Boven","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands."},{"name":"Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands."},{"name":"Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.2147\/DDDT.S262141"},{"key":"e_1_3_4_3_2","unstructured":"United Nations Environment Programme. 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