DeCanio Stephen J, Norman Catherine S
UCSB Washington Program, 1608 Rhode Island Avenue, NW, Washington, DC 20036, USA.
J Environ Manage. 2007 Oct;85(1):1-8. doi: 10.1016/j.jenvman.2006.07.005. Epub 2006 Sep 18.
The Montreal Protocol on Substances that Deplete the Ozone Layer has led to rapid reductions in the use of ozone-depleting substances worldwide. However, the Protocol provides for "essential use exemptions" (EUEs) if there are no "technically and economically feasible" alternatives. An application that might qualify as an "essential use" is CFC-powered medical metered-dose inhalers (MDIs) for the treatment of asthma and chronic obstructive pulmonary disease (COPD), and the US and other nations have applied for exemptions in this case. One concern is that exemptions are necessary to ensure access to medications for low-income uninsureds. We examine the consequences of granting or withholding such exemptions, and conclude that government policies and private-sector programs are available that make it economically feasible to phase out chlorofluorocarbons (CFCs) in this application, thereby furthering the global public health objectives of the Montreal Protocol without compromising the treatment of patients who currently receive medication by means of MDIs.
《关于消耗臭氧层物质的蒙特利尔议定书》已促使全球范围内消耗臭氧层物质的使用量迅速减少。然而，如果没有“技术上和经济上可行的”替代品，该议定书允许有“必要用途豁免”（EUE）。一种可能符合“必要用途”的应用是用于治疗哮喘和慢性阻塞性肺病（COPD）的以氯氟烃为动力的医用定量吸入器（MDI），美国和其他国家已就此申请豁免。一个担忧是，豁免对于确保低收入未参保者获得药物是必要的。我们研究了给予或拒绝此类豁免的后果，并得出结论：政府政策和私营部门项目能够使在此应用中逐步淘汰氯氟烃在经济上可行，从而在不影响目前通过定量吸入器接受药物治疗的患者治疗的情况下，进一步推进《蒙特利尔议定书》的全球公共卫生目标。
