Carbon footprint impact of the choice of inhalers for asthma and COPD

Janson, Christer; Henderson, Richard W.; Löfdahl, Magnus; Hedberg, Martin; Sharma, Raj Kumar; Wilkinson, Alexander

doi:10.1136/thoraxjnl-2019-213744

Cited by 152 publications

(158 citation statements)

References 3 publications

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“…Switching to dry powder inhalers can save drug related greenhouse gas emissions and financial costs simultaneously 18. In 2017, 70% of all inhalers sold in England were metered dose inhalers compared with 13% in Sweden, where there has been a more rapid transition to dry powder inhalers 19. Guidance from the National Institute for Health and Care Excellence (NICE) in England has already stated that both patient and population health need to be considered when prescribing inhalers 20…”

Section: Reducing Avoidable Emissions and Ecological Damagementioning

confidence: 99%

Making healthcare and health systems net zero

Pencheon

Wight

2020

BMJ

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Section: Reducing Avoidable Emissions and Ecological Damagementioning

confidence: 99%

Making healthcare and health systems net zero

Pencheon

Wight

2020

BMJ

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“…22 It was calculated that if England applied the Swedish distribution of pMDIs and DPIs, 550 kt of CO 2 would be saved annually-which corresponds to approximately 2.6% of NHS England's total carbon footprint. 22 Furthermore, the inappropriate disposal of pMDIs contributes further to their environmental impact. 23 Although some pMDIs do have dose counter mechanisms, this is not universal (in contrast to DPIs) and means that patients may not know how many doses are left in their inhalers.…”

Section: Environmental Impac Tmentioning

confidence: 99%

“…In fact, it has been widely reported that the proportion of patients using the correct technique with pMDIs without a spacer is low. Two separate studies reported correct technique using a pMDI as compared with DPIs to be 23%‐43% and 53%‐59% respectively 18,22 . Effective use of a DPI requires the patient to generate a peak inspiratory flow (PIF) that overcomes the internal resistance of the inhaler.…”

Section: Clinical Effectivenessmentioning

confidence: 99%

Climate change in healthcare: Exploring the potential role of inhaler prescribing

Starup-Hansen

Dunne²,

Sadler

et al. 2020

Pharmacology Res & Perspec

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Climate change has been described as the biggest global health threat of the 21st century. As a result, governments around the world are committing to legislative change in order to reduce greenhouse gas emissions (GHGEs). The healthcare sector makes a significant contribution to GHGEs and in line with national legislation in the UK, the NHS has recently committed to achieving net zero emissions by 2050. The management of asthma and COPD largely depends on the prescribing of medications that are delivered through inhalers. In the UK, the use of pressurized metered dose inhalers (pMDIs), which rely on hydrofluorocarbon (HFC) propellants accounts for 3.5% of the NHS’s total carbon footprint. In contrast, dry powder inhalers (DPIs) have a much lower carbon footprint due to the absence of a HFC propellant. Here we review evidence of the impact of inhaler choices across four domains: environmental impact, clinical effectiveness, cost effectiveness and patient preferences. We find that as well as a lower global‐warming potential, DPIs have additional benefits over pMDIs in other domains and should be considered first line where clinically appropriate.

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“… 1 The ELLIPTA DPI device, compared with MDIs, has been associated with shorter training times, fewer errors in use, less requirement for coordination, environmental benefits and greater patient preference, with implications for adherence and potentially treatment outcomes. 2 , 3 The ELLIPTA DPI has also been shown to be easy to use with few errors in use across different age groups in patients with COPD. 4 In order to use DPIs adequately, patients must generate a level of inspiratory effort based on the internal resistance of the inhaler, and thereby provide energy for dose emission and de-aggregation of the inhalation powder to generate particles of a suitable size for deposition within the lower respiratory tract.…”

Section: Introductionmentioning

confidence: 99%

Peak Inspiratory Flow Rate in COPD: An Analysis of Clinical Trial and Real-World Data

Anderson¹,

Collison²,

Drummond³

et al. 2021

COPD

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Background The influence of peak inspiratory flow (PIF) on dose delivery from dry powder inhalers (DPIs) and association with treatment efficacy in patients with chronic obstructive pulmonary disease (COPD) has not been fully determined. In vitro studies have demonstrated adequate dose delivery through ELLIPTA DPI at PIF ≥30 L/min. This analysis of two clinical trials and a real-world population of COPD patients determined spirometric PIF distribution, and explored the relationship between PIF and outcomes in the trials. Methods The replicate Phase IV, 12-week, randomized, double-blind 207608/207609 (NCT03478683/NCT03478696) trials evaluated fluticasone furoate/umeclidinium/vilanterol via ELLIPTA DPI versus budesonide/formoterol+tiotropium in COPD patients. This post hoc analysis assessed spirometric PIF distribution at screening and relationship between PIF and lung function outcomes in the pooled 207608/207609 population. Spirometric PIF distributions in a real-world population of COPD patients were evaluated by retrospective analysis of the Kaiser Permanente Northwest (KPNW) database to assess similarities between clinical trial and real-world populations. Results A total of 1460 (207608/207609) and 3282 (KPNW) patients were included. There was considerable overlap between spirometric PIF distributions for both populations. Overall, 99.7% and 99.8% of the 207608/207609 and KPNW populations, respectively, reported spirometric PIF ≥50 L/min, estimated as equivalent to ELLIPTA PIFR ≥30 L/min. In the 207608/207609 combined analysis, there was no significant interaction between spirometric PIF and treatment for lung function endpoints, indicating treatment effect is independent of PIF. Conclusion Nearly all COPD patients in the 207608/207609 and KPNW populations achieved spirometric PIF values estimated as equivalent to PIFR of ≥30 L/min through the ELLIPTA DPI. Lack of correlation between spirometric PIF at screening and treatment efficacy aligns with consistent dose performance from the ELLIPTA DPI across a wide range of PIFs, achieved by patients with COPD of all severities.

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Carbon footprint impact of the choice of inhalers for asthma and COPD

Cited by 152 publications

References 3 publications

Making healthcare and health systems net zero

Making healthcare and health systems net zero

Climate change in healthcare: Exploring the potential role of inhaler prescribing

Peak Inspiratory Flow Rate in COPD: An Analysis of Clinical Trial and Real-World Data

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