Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study

Kocks, Janwillem; Ferreira, António; Schayck, Onno van; Ekroos, Heikki; Tzanakis, Νikolaos; Soulard, Stéphane; Haaksma-Herczegh, Monika; Mestres-Simon, Montserrat; Águila-Fuentes, Malena; Cataldo, Didier

doi:10.21203/rs.3.rs-1652896/v1

Cited by 2 publications

(3 citation statements)

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“…[32] Patient education of carbon footprint must also be coupled with that of education of clinicians, where it has been shown that few understand the carbon footprint of devices and the presence or absence of propellants. [33] Ultimately, the greenest inhaler is a clinically appropriate device, that gives patients clinical benefit. [34]…”

Section: Discussionmentioning

confidence: 99%

“…Reusability and carbon footprint of the device are strong drivers of patient preference [ 30 , 31 ], and when patients are made aware of the carbon footprint of their inhalers, many are willing to try a more environmentally friendly device [ 32 ]. Patient education on carbon footprint must also be coupled with that of education of clinicians, where it has been shown that few understand the carbon footprint of devices and the presence or absence of propellants [ 33 ]. Ultimately, the greenest inhaler is a clinically appropriate device that gives patients clinical benefit [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Reducing carbon footprint by switching to reusable soft-mist inhalers

et al. 2023

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ObjectiveInhalation therapy is the cornerstone of chronic obstructive pulmonary disease, together with non-pharmacological treatments. Long-acting muscarinic antagonists (LAMAs), alone or in combination with long-acting beta agonists (LABAs), are commonly used. Pressurised metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs) are used, each with different carbon footprints. This study aimed to assess the carbon footprint of hypothetically replacing LAMA or LAMA/LABA inhalers with an SMI, Respimat Reusable, within the same therapeutic class.MethodsAn environmental impact model was established to assess the change in carbon footprint of replacing pMDIs/DPIs with Respimat Reusable within the same therapeutic class (LAMA or LAMA/LABA), across 12 European countries and the United States over 5 years. Inhaler use for country and disease-specific populations was derived from international prescribing data and the associated carbon footprint (CO2equivalents) were identified from published sources.ResultsOver 5 years and across all countries, replacing LAMA inhalers with Spiriva Respimat Reusable reduced CO2e emissions by 13.3–50.9%, saving 93–6228 tonnes of CO2e in the different countries studied. Replacing LAMA/LABA inhalers with Spiolto Respimat Reusable reduced CO2e emissions by 9.5–92.6%, saving 31–50 843 tonnes of CO2e. In scenario analyses, which included total replacement of DPIs/pMDIs, consistent CO2e savings were estimated. Sensitivity analyses showed that results were sensitive to changes in several parameters including varying assumptions around re-usability of inhalers and potential CO2e impact.ConclusionReplacement of pMDIs and DPIs with Respimat Reusable within the same therapeutic class, would result in substantial reductions in CO2e emissions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reducing carbon footprint by switching to reusable soft-mist inhalers

et al. 2023

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“…ICS are widely prescribed in COPD, either alone or in combination with other drugs; reports in the literature estimate that up to 86% of COPD patients are treated with ICS, regardless of COPD severity and exacerbation risk [91]. The high percentage of COPD patients being prescribed ICS-based maintenance therapy was confirmed in a recent Delphi survey of COPD management across six European countries [92].…”

Section: Expert Opinionmentioning

confidence: 95%

Use of thiols and implications for the use of inhaled corticosteroids in the presence of oxidative stress in COPD

Cazzola¹,

Page²,

Wedzicha³

et al. 2023

Respir Res

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Background Oxidative stress and persistent airway inflammation are thought to be important contributors to the development of chronic obstructive pulmonary disease (COPD). This review summarizes the evidence for targeting oxidative stress and inflammation in patients with COPD with mucolytic/antioxidant thiols and inhaled corticosteroids (ICS), either alone or in combination. Main body Oxidative stress is increased in COPD, particularly during acute exacerbations. It can be triggered by oxidant air pollutants and cigarette smoke and/or by endogenous reactive oxygen species (ROS) released from mitochondria and activated inflammatory, immune and epithelial cells in the airways, together with a reduction in endogenous antioxidants such as glutathione (GSH). Oxidative stress also drives chronic inflammation and disease progression in the airways by activating intracellular signalling pathways and the release of further inflammatory mediators. ICS are anti-inflammatory agents currently recommended for use with long-acting bronchodilators to prevent exacerbations in patients with moderate-to-severe COPD, especially those with eosinophilic airway inflammation. However, corticosteroids can also increase oxidative stress, which may in turn reduce corticosteroid sensitivity in patients by several mechanisms. Thiol-based agents such as erdosteine, N-acetyl L-cysteine (NAC) and S-carboxymethylcysteine (S-CMC) are mucolytic agents that also act as antioxidants. These agents may reduce oxidative stress directly through the free sulfhydryl groups, serving as a source of reducing equivalents and indirectly though intracellular GSH replenishment. Few studies have compared the effects of corticosteroids and thiol agents on oxidative stress, but there is some evidence for greater antioxidant effects when they are administered together. The current Global Initiative for Chronic Obstructive Lung Disease (GOLD) report supports treatment with antioxidants (erdosteine, NAC, S-CMC) in addition to standard-of-care therapy as they have been demonstrated to reduce COPD exacerbations. However, such studies have demonstrated that NAC and S-CMC reduced the exacerbation risk only in patients not treated with ICS, whereas erdosteine reduced COPD exacerbations irrespective of concomitant ICS use suggesting that erdosteine has additional pharmacological actions to ICS. Conclusions Further clinical trials of antioxidant agents with and without ICS are needed to better understand the place of thiol-based drugs in the treatment of patients with COPD.

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Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study

Cited by 2 publications

References 28 publications

Reducing carbon footprint by switching to reusable soft-mist inhalers

Reducing carbon footprint by switching to reusable soft-mist inhalers

Use of thiols and implications for the use of inhaled corticosteroids in the presence of oxidative stress in COPD

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