CEO, Aequilibria Srl-SB, Venezia, Italy.
NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK.
BMJ Open Respir Res. 2021 Dec;8(1). doi: 10.1136/bmjresp-2021-001071.
Inhaled therapies are key components of asthma and chronic obstructive pulmonary disease (COPD) treatments. Although the use of pressurised metered-dose inhalers (pMDIs) accounts for <0.1% of global greenhouse gas emissions, their contribution to global warming has been debated and efforts are underway to reduce the carbon footprint of pMDIs. Our aim was to establish the extent to which different scenarios led to reductions in greenhouse gas emissions associated with inhaler use, and their clinical implications.
We conducted a series of scenario analyses using asthma and COPD inhaler usage data from 2019 to model carbon dioxide equivalent (COe) emissions reductions over a 10-year period (2020-2030) in the UK, Italy, France, Germany and Spain: switching propellant-driven pMDIs for propellant-free dry-powder inhalers (DPIs)/soft mist inhalers (SMIs); transitioning to low global warming potential (GWP) propellant (hydrofluoroalkane (HFA)-152a) pMDIs; reducing short-acting β-agonist (SABA) use; and inhaler recycling.
Transition to low-GWP pMDIs and forced switching to DPI/SMIs (excluding SABA inhalers) would reduce annual COe emissions by 68%-84% and 64%-71%, respectively, but with different clinical implications. Emission reductions would be greatest (82%-89%) with transition of both maintenance and SABA inhalers to low-GWP propellant. Only minimising SABA inhaler use would reduce COe emissions by 17%-48%. Although significant greenhouse gas emission reductions would be achieved with high rates of end-of-life recycling (81%-87% of the inhalers), transition to a low-GWP propellant would still result in greater reductions.
While the absolute contribution of pMDIs to global warming is very small, substantial reductions in the carbon footprint of pMDIs can be achieved with transition to low-GWP propellant (HFA-152a) inhalers. This approach outperforms the substitution of pMDIs with DPI/SMIs while preserving patient access and choice, which are essential for optimising treatment and outcomes. These findings require confirmation in independent studies.
吸入疗法是哮喘和慢性阻塞性肺疾病（COPD）治疗的关键组成部分。虽然加压计量吸入器（pMDI）的使用仅占全球温室气体排放量的<0.1%，但其对全球变暖的贡献仍存在争议，目前正在努力减少 pMDI 的碳足迹。我们的目的是确定不同方案在多大程度上减少了与吸入器使用相关的温室气体排放，以及它们对临床的影响。
我们使用 2019 年哮喘和 COPD 吸入器使用数据进行了一系列方案分析，以在英国、意大利、法国、德国和西班牙建立在 10 年内（2020-2030 年）减少二氧化碳当量（COe）排放的方案：将推进剂驱动的 pMDI 转换为无推进剂干粉吸入器（DPI）/软雾吸入器（SMI）；过渡到低全球变暖潜能值（GWP）推进剂（氢氟烷烃（HFA）-152a）pMDI；减少短效β-激动剂（SABA）的使用；以及吸入器回收。
向低 GWP pMDI 过渡和强制转换为 DPI/SMI（不包括 SABA 吸入器）将分别使每年的 COe 排放量减少 68%-84%和 64%-71%，但具有不同的临床意义。向低 GWP 推进剂过渡可使维持和 SABA 吸入器的转换最大程度地减少排放（82%-89%）。只有尽量减少 SABA 吸入器的使用才能使 COe 排放量减少 17%-48%。尽管通过高比例的使用寿命结束回收（81%-87%的吸入器）可实现显著的温室气体减排，但向低 GWP 推进剂的过渡仍将导致更大的减排。
虽然 pMDI 对全球变暖的绝对贡献非常小，但通过向低 GWP 推进剂（HFA-152a）吸入器过渡，可以显著减少 pMDI 的碳足迹。与用 DPI/SMI 替代 pMDI 相比，这种方法的效果更好，同时还能保留患者的获得途径和选择，这对于优化治疗和结果至关重要。这些发现需要在独立研究中得到证实。
