Emergency MDI and spacer packs for asthma and COPD

Keeley, Duncan; Partridge, Martyn R

doi:10.1016/s2213-2600(19)30046-3

Cited by 16 publications

(7 citation statements)

References 5 publications

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“…Switching to DPI SABAs could potentially lead to a simplification of inhalation technique, an improvement in care and a reduction in carbon footprint. A recent proposal suggests a reliever MDI+spacer could be kept separately in an emergency pack in case of exacerbations 45. Whatever inhalers are used, adequate patient training and assessment of inhaler technique will be essential for efficient and effective inhaler use 29…”

Section: Discussionmentioning

confidence: 99%

Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England

et al. 2019

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ObjectivesMetered-dose inhalers (MDIs) contain propellants which are potent greenhouse gases. Many agencies propose a switch to alternative, low global warming potential (GWP) inhalers, such as dry powder inhalers (DPIs). We aimed to analyse the impact on greenhouse gas emissions and drug costs of making this switch.SettingWe studied National Health Service prescription data from England in 2017 and collated carbon footprint data on inhalers commonly used in England.DesignInhalers were separated into different categories according to their mechanisms of action (eg, short-acting beta-agonist). Within each category we identified low and high GWP inhalers and calculated the cost and carbon impact of changing to low GWP inhalers. We modelled scenarios for swapping proportionally according to the current market share of each equivalent DPI (model 1) and switching to the lowest cost pharmaceutically equivalent DPI (model 2). We also reviewed available data on the carbon footprint of inhalers from scientific publications, independently certified reports and patents to provide more accurate carbon footprint information on different types of inhalers.ResultsIf MDIs using HFA propellant are replaced with the cheapest equivalent DPI, then for every 10% of MDIs changed to DPIs, drug costs decrease by £8.2M annually. However if the brands of DPIs stay the same as 2017 prescribing patterns, for every 10% of MDIs changed to DPIs, drug costs increase by £12.7M annually. Most potential savings are due to less expensive long-acting beta-agonist (LABA)/inhaled corticosteroids (ICS) inhalers. Some reliever inhalers (eg, Ventolin) have a carbon footprint over 25 kg CO2e per inhaler, while others use far less 1,1,1,2-tetrafluoroethane (HFA134a) (eg, Salamol) with a carbon footprint of <10 kg CO2e per inhaler. 1,1,1,2,3,3,3-Heptafluoropropane (HFA227ea) LABA/ICS inhalers (eg, Flutiform) have a carbon footprint over 36 kg CO2e, compared with an equivalent HFA134a combination inhaler (eg, Fostair) at <20 kg CO2e. For every 10% of MDIs changed to DPIs, 58 kt CO2e could be saved annually in England.ConclusionsSwitching to DPIs would result in large carbon savings and can be achieved alongside reduced drug costs by using less expensive brands. Substantial carbon savings can be made by using small volume HFA134a MDIs, in preference to large volume HFA134a MDIs, or those containing HFA227ea as a propellant.

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Section: Discussionmentioning

confidence: 99%

Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England

et al. 2019

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“…It is therefore very important to ensure continued access to this treatment method for the self-management of exacerbations. One way of achieving this in patients who are being offered DPIs in lieu of pMDIs for routine treatment is to provide an emergency treatment pack with pMDIs and a spacer for use in exacerbations [9].…”

Section: What Is the Association Between Inhaler Propellants And Globmentioning

confidence: 99%

Minimising the environmental impact of inhaled therapies: problems with policy on low carbon inhalers

2020

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“…To overcome challenges in actuation-breathe coordination, pressurized metered dose inhalers (pMDIs) are recommended to be combined with a spacer device [1][2][3]. However, inhalers and spacer devices only work when properly used and this turns out to be an ongoing challenge for patients and clinicians [4].…”

Section: Introductionmentioning

confidence: 99%

Digital spacer data driven COPD inhaler adherence education: The OUTERSPACE proof-of-concept study

Dierick

Been-Buck

Klemmeier

et al. 2022

Respiratory Medicine

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Emergency MDI and spacer packs for asthma and COPD

Cited by 16 publications

References 5 publications

Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England

Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England

Minimising the environmental impact of inhaled therapies: problems with policy on low carbon inhalers

Digital spacer data driven COPD inhaler adherence education: The OUTERSPACE proof-of-concept study

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