The carbon footprint of respiratory treatments in Europe and Canada: an observational study from the CARBON programme

Janson, Christer; Maslova, Ekaterina; Wilkinson, Alexander; Penz, Erika; Papi, Alberto; Budgen, Nigel; Vogelmeier, Claus; Kupczyk, Maciej; Bell, John P.; Menzies‐Gow, Andrew

doi:10.1183/13993003.02760-2021

Cited by 19 publications

(24 citation statements)

References 18 publications

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“…Whilst it seems that a combination of long-acting b-agonists (LABA) and inhaled corticosteroids (ICS) dominate the global respiratory market, SABAs alone contribute to half of the market share based on the number of doses prescribed 7 . This is also coupled with the findings from the CARBON program that show that SABA use is common in Europe and Canada, with significant SABA GHG emissions 8 . When compared to total inhaler emissions, Greece contributes 62% of SABA GHG emissions, followed by the UK (68%) and Romania (80%) 8 .…”

Section: Introductionmentioning

confidence: 54%

“…This is also coupled with the findings from the CARBON program that show that SABA use is common in Europe and Canada, with significant SABA GHG emissions 8 . When compared to total inhaler emissions, Greece contributes 62% of SABA GHG emissions, followed by the UK (68%) and Romania (80%) 8 . Therefore, it is not unreasonable to conclude that a large part of pMDI emissions are due to reliever use.…”

Section: Introductionmentioning

confidence: 54%

“…Reports have shown that many patients are overprescribed to a SABA but underuse their inhaled corticosteroids (ICS) 36,37 . This is supported by data that show that the majority of SABA prescriptions were given to patients that overuse, with a range of 69% (Italy and Sweden) to 85% (UK) in Europe 8 . Therefore, initiating a preventer inhaler that the patient can and will use regularly, could decrease the global warming impact as the patient is controlled by using the lowest effective dose and less propellant 25 .…”

Section: A Patient-centered Approach To Inhaler Therapymentioning

confidence: 67%

“…Identifying SABA overuse and initiating the correct treatment regime Firstly, the correct treatment must be initiated and at the most optimal dose. Compared to its other European counterparts, the UK has the greatest per capita use of SABA and controller inhalers, with 61% of prescriptions of pMDIs being for SABAs 8,35 . Overuse of SABAs (more than three prescriptions a year) is a sign of uncontrolled asthma and an indicator of sub-optimal medicine management.…”

Section: A Patient-centered Approach To Inhaler Therapymentioning

confidence: 99%

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Inhalers and the Environment: Pollution, Plastics and Policy

Chakma¹,

Usmani²

2022

Pneumon

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The effects of the climate crisis have been well established with the first global efforts to address the issue made over 30 years ago. The global healthcare sector is a large contributor to the total greenhouse gas (GHG) emissions, with the recent focus on the respiratory care sector. However, recent directives to address these emissions include 'blanket unconsented switching' of stable respiratory patients from pressurized metered dose inhalers (pMDIs) to dry powder inhalers (DPIs), which has the potential to cause a multitude of serious consequences for the patient. This article reviews the broad consequences and provides recommendations to encourage an environmentally friendly patientcentered approach without causing harm to the patient.

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Section: Introductionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 54%

Section: A Patient-centered Approach To Inhaler Therapymentioning

confidence: 67%

Section: A Patient-centered Approach To Inhaler Therapymentioning

confidence: 99%

See 2 more Smart Citations

Inhalers and the Environment: Pollution, Plastics and Policy

Chakma¹,

Usmani²

2022

Pneumon

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“…59,70 Recently, an observational cohort study has quantified the carbon footprint associated to SABA overuse, based on the global warming potential of hydrofluorocarbon propellants contained in metereddose inhalers (MDIs). 71 After analysing data from Europe and Canada, the authors conclude that SABA overuse dispensed by MDIs is associated with the excess of greenhouse gas emissions per capita, which increase the carbon footprint of respiratory treatment. 72…”

Section: Discussionmentioning

confidence: 99%

Landscape of short‐acting beta‐agonists (SABA) overuse in Europe

Vecillas¹,

Quirce²

2022

Clin Experimental Allergy

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This review article provides an overview of short-acting beta-agonist (SABA) use and prescribing trends in Europe, summarizing updated data on the results from the industry-funded SABINA program (SABA use IN asthma) and other studies on this matter. SABA use continues to increase worldwide. Overuse has been defined as ≥3 canisters/year. Almost a third of European patients with asthma, at all severity levels, overuse SABA. Guidelines recommend close monitoring of patients who overuse SABA and avoiding over-reliance on SABA monotherapy. SABA overuse is associated with increased risk of asthma exacerbations and mortality, increased use of health services and negative physical and mental health outcomes. Reliance on SABA monotherapy can be unsafe and therefore it is necessary to change asthma treatment approaches and policies. Changes in physician and patient behaviours towards SABA use are required to ensure that patients with asthma are not over-reliant on SABA monotherapy. Notwithstanding, the limitations of the studies on the use of SABA should be considered, taking into account that the prescription/purchase of medication canisters does not always represent the actual use of the medication and that associations between SABA overuse and poor asthma outcomes may not be directly causal. National health systems and asthma guidelines must align asthma management with global recommendations and adjust them to local needs.

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Greenhouse Gas Emissions from Respiratory Treatments: Results from the SABA CARBON International Study

Alzaabi,

Bell,

Montero-Arias

et al. 2023

Adv Ther

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Introduction Healthcare systems are looking to reduce their carbon impact. Short-acting β 2 -agonist (SABA) overuse (≥ 3 canisters/year) is common in asthma and linked to poor outcomes; however, its environmental impact remains unknown. As part of the CARBON programme, this study retrospectively quantified the carbon footprint of SABA and controller inhalers across all respiratory indications and SABA overuse in asthma in lower-middle-income countries (LMICs), upper-middle-income countries and high-income countries across Africa, Asia Pacific, Latin America and the Middle East. Methods Two data sources were utilised to evaluate the carbon contribution of inhalers to respiratory care. To quantify greenhouse gas (GHG) emissions associated with total inhaler use across all respiratory indications, inhaler sales data were obtained from IQVIA MIDAS ® (Q4/2018–Q3/2019) and compared by dose to prevent confounding from differences in canister actuation counts. GHG emissions associated with SABA overuse in asthma were evaluated using prescription and self-reported over-the-counter purchase data from the SABA use IN Asthma (SABINA) III study (2019–2020). Inhaler-related GHG emissions were quantified using published data and product life cycle assessments. Results SABA accounted for > 50% of total inhaler use and inhaler-related emissions in most countries analysed. The total SABA-related emissions were estimated at 2.7 million tonnes carbon dioxide equivalents, accounting for 70% of total inhaler-related emissions. Among the countries, regions and economies analysed, per capita SABA use and associated emissions were higher in Australia, the Middle East and high-income countries. Most SABA prescriptions for asthma (> 90%) were given to patients already overusing SABA. Conclusions Globally, SABA use/overuse is widespread and is the greatest contributor to the carbon footprint of respiratory treatment, regardless of the economic status of countries. Implementing evidence-based treatment recommendations, personalising treatment and reducing healthcare inequities, especially in LMICs, may improve disease control and patient outcomes, thereby reducing SABA overuse and associated carbon emissions beyond SABA use alone. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02663-2.

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The carbon footprint of respiratory treatments in Europe and Canada: an observational study from the CARBON programme

Cited by 19 publications

References 18 publications

Inhalers and the Environment: Pollution, Plastics and Policy

Inhalers and the Environment: Pollution, Plastics and Policy

Landscape of short‐acting beta‐agonists (SABA) overuse in Europe

Greenhouse Gas Emissions from Respiratory Treatments: Results from the SABA CARBON International Study

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