Declaration on the Phase-out of Metered Dose Inhalers (MDI's) Containing CFC
Discussed and approved at the 7th ISDE World Assembly (Chicago, 1997)

The International Society of Doctors for the Environment ISDE with its 33 national and regional associations representing some 20.000 physicians in over 100 countries (direct and collective members are more than 500.000) is concerned about the continued use of metered doses inhalers MDI's containing CFC's in the treatment of asthma and COPD.

We can no longer accept, that a medical treatment contributes to the destruction of the ozone layer and the linked dangerous threats to human health and the ecosystem, since there are equivalent alternatives.

Therefore we call upon:

- the parties to the Montreal Protocol meeting in Montreal on:
* ceasing the exemption for MDI's automatically as soon as a technically and economically feasible alternative (TEFA) is available with a transition period of no longer than 2 years (for the first substances the alternatives are now available).
- all governments and drug registering authorities:
* not to allow any new MDI containing CFC.
* to withdraw the registration of CFC containing MDI's after a transition period when the same substance is available in CFC free MDI's.
* to inform and educate patients and physicians about the availability and importance and to promote the use of CFC free alternatives (dry powder inhalers DPI, nebulisers or CFC free MDI's).
- the pharmaceutical industry:
* to switch as quickly as technically possible to CFC free alternatives.
* to collaborate with each other for a fast transition.
* not to invest any resources in the development of new products containing CFC, in the promotion of existing products containing CFC or in the lobbying against a quick and strong regulation of the transition at national and international level.
- our members and all physicians and patients:
* to change as soon as available to a CFC free alternative of the same or a similar substance (even if they have to get used to another brand name).

ISDE does not ask for a lower quality therapy for patients who need it, but in view of the existing and forthcoming alternatives, we cannot accept a further contribution of a medical therapy to such an important threat to human health, as the ozone depletion.