An Assessment of Pressurized Metered-dose Inhaler Use in Countries in Europe and the Rest of the World

Bell, J.P.; Ringall, A.; Khezrian, M.; Kocks, Janwillem; Usmani, O.S.

doi:10.1164/ajrccm-conference.2023.207.1_meetingabstracts.a6315

Cited by 3 publications

(1 citation statement)

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“…Of the three delivery device types, pMDIs are most used globally (~78%) with greater than 90% use in some countries (Bell et al, 2022). Historically, pMDIs used chlorofluorocarbon (CFC) as a propellant, which was known to deplete the ozone layer in the atmosphere.…”

Section: Introductionmentioning

confidence: 99%

Pressurized metered-dose inhalers using next-generation propellant HFO-1234ze(E) deposit negligible amounts of trifluoracetic acid in the environment

Tewari,

Bell,

Budgen

et al. 2023

Preprint

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Pressurized metered-dose inhalers (pMDIs) deliver life-saving medications to patients with respiratory conditions and are the most used inhaler delivery device globally. pMDIs utilize a hydrofluoroalkane (HFA), also known as an F-gas, as a propellant to facilitate the delivery of medication into the lungs by inhalation. Although HFAs have minimal impact on ozone depletion, their global warming potential (GWP) is more than 1,000 times higher than CO2, bringing them in scope for restriction under the F-Gas Regulation in the European Union (EU). The pharmaceutical industry is developing solutions, including a near-zero GWP ‘next-generation propellant,’ HFO-1234ze(E). At the same time, the EU is also evaluating a restriction on per-and polyfluoroalkyl substances (PFAS) under the Registration, Evaluation, Authorization, and Restriction of Chemicals (REACH) regulation. Trifluoroacetic acid (TFA) is a persistent PFAS and a potential degradation product of HFO-1234ze(E). We have quantified yield of TFA from HFO-1234ze(E) using a computational model under Europe-relevant atmospheric conditions. The modeling suggests that most HFO-1234ze(E) degrades into formyl fluoride within 20 days (≥85%) even at the highest examined altitude. These modeling results suggest that TFA yield from HFO-1234ze(E) varies between 0-4% under different atmospheric conditions. Using France as an example, assuming pMDIs sold in a year (21 million) had HFO-1234ze(E) propellant, we estimate an annual rainwater TFA deposition of ~0.025 parts-per-billion. These results demonstrate negligible formation of TFA as a degradation product of HFO-1234ze(E) further supporting its suitability as a non-persistent, non-bioaccumulative, and non-toxic future propellant for pMDI devices to safeguard access for patients to these essential medicines.

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Section: Introductionmentioning

confidence: 99%

Pressurized metered-dose inhalers using next-generation propellant HFO-1234ze(E) deposit negligible amounts of trifluoracetic acid in the environment

Tewari,

Bell,

Budgen

et al. 2023

Preprint

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Prioritising Patient Outcomes and Reducing Environmental Burden: How Both Are Achievable in Respiratory Care

Moir,

Taylor

2023

EMJ Respir

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Patient outcomes must take precedence when considering environmental legislation related to the availability of inhaler devices, which are essential for the care of patients with respiratory diseases. This article reviews presentations and abstracts from the European Respiratory Society (ERS) International Congress 2023, held in Milan, Italy, in September 2023. The sessions focused on healthcare inequality and patient outcomes, highlighting the need for stakeholders to make patient-centric decisions in order to ensure access to essential inhaled medicines are prioritised. This is especially important during a period when there is an increasing need to reduce the carbon footprint associated with respiratory care. During a satellite symposium, co-chairs John Hurst, Professor of Respiratory Medicine at University College London (UCL), UK, and Helen Reddel, Research Leader at the Woolcock Institute of Medical Research, Sydney, Australia, emphasised the necessity of addressing environmentally sustainable respiratory care while prioritising patient outcomes. Christine Jenkins, Clinical Professor of Respiratory Medicine at the University of New South Wales (UNSW), Sydney, Australia, discussed the association between health inequity and uncontrolled chronic obstructive pulmonary disease (COPD) and asthma, and how that relates to the carbon footprint of treatment. Alberto Papi, Full Professor of Respiratory Medicine at the University of Ferrara, Italy, examined how implementing evidence-based guidelines can improve patient outcomes and reduce the carbon footprint of respiratory care, and the progress being made in the transition to near-zero propellants in pressurised metered-dose inhaler (pMDI) devices. Omar Usmani, Professor of Respiratory Medicine at the National Heart and Lung Institute (NHLI), Imperial College London, UK, stressed that pMDIs contain essential medicines, and inhaler regimens should not be considered readily interchangeable. He urged the respiratory community to ensure that their voice is heard in decisions where it relates to the environment regarding COPD and asthma care. The symposium emphasised the opportunities to reduce the environmental impact of respiratory care whilst prioritising patient outcomes. By supporting the transition to climate-friendly propellants in pMDI devices, and implementing guidelines to improve patient outcomes, the overall carbon footprint of respiratory care can be reduced. However, this must be done without limiting access to essential medicines, or increasing adverse health outcomes. The symposium identified pathways towards achieving patient-centric, sustainable respiratory care by improving outcomes, harnessing innovation, and promoting multi-stakeholder collaboration.

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Å velge pulverinhalator gir vesentlig miljøgevinst

Bull-Hansen,

Misje,

Vereide

et al. 2024

Tidsskriftet

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An Assessment of Pressurized Metered-dose Inhaler Use in Countries in Europe and the Rest of the World

Cited by 3 publications

References 0 publications

Pressurized metered-dose inhalers using next-generation propellant HFO-1234ze(E) deposit negligible amounts of trifluoracetic acid in the environment

Pressurized metered-dose inhalers using next-generation propellant HFO-1234ze(E) deposit negligible amounts of trifluoracetic acid in the environment

Prioritising Patient Outcomes and Reducing Environmental Burden: How Both Are Achievable in Respiratory Care

Å velge pulverinhalator gir vesentlig miljøgevinst

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