National Health Care Institute, Diemen, The Netherlands.
Respiratory Medicine, Van Weel-Bethesda Hospital, Middelharnis, The Netherlands.
BMJ Open. 2022 Jun 14;12(6):e055546. doi: 10.1136/bmjopen-2021-055546.
Dry powder inhalers (DPIs) and soft mist inhalers have a substantially lower global warming potential than pressurised metered-dose inhalers (pMDIs). To help mitigate climate change, we assessed the potential emission reduction in CO equivalents when replacing pMDIs by non-propellant inhalers (NPIs) in Dutch respiratory healthcare and estimated the associated cost.
We performed a descriptive analysis of prescription data from two national databases of two independent governmental bodies. First, we calculated the number of patients with chronic obstructive pulmonary disease (COPD) and asthma that were using inhalation medication (2020). Second, we calculated the number and total of daily defined doses of pMDIs and NPIs including DPIs and soft mist inhalers, as well as the number of dispensed spacers per patient (2020). Third, we estimated the potential emission reduction in CO equivalents if 70% of patients would switch from using pMDIs to using NPIs. Fourth, we performed a budget impact analysis.
Dutch respiratory healthcare.
The carbon footprint of current inhalation medication and the environmental and financial impact of replacing pMDIs with NPIs.
In 2020, 1.4 million patients used inhalers for COPD or asthma treatment. A total of 364 million defined daily doses from inhalers were dispensed of which 49.6% were dispensed through pMDIs. We estimated that this could be reduced by 70% which would lead to an annual reduction in greenhouse gas emission of 63 million kg.CO2 equivalents saving at best EUR 49.1 million per year.
In the Netherlands, substitution of pMDIs to NPIs for eligible patients is theoretically safe and in accordance with medical guidelines, while reducing greenhouse gas emission by 63 million kg.CO2 equivalents on average and saving at best EUR 49.1 million per year. This study confirms the potential climate and economic benefit of delivering a more eco-friendly respiratory care.
干粉吸入器（DPIs）和软雾吸入器的全球变暖潜能值明显低于压力定量吸入器（pMDIs）。为了帮助减轻气候变化，我们评估了当用非推进式吸入器（NPIs）替代 pMDIs 时，以 CO 当量计的潜在减排量，并估计了相关成本。
我们对来自两个独立政府机构的两个国家数据库的处方数据进行了描述性分析。首先，我们计算了使用吸入药物的慢性阻塞性肺疾病（COPD）和哮喘患者人数（2020 年）。其次，我们计算了 pMDIs 和 NPIs（包括 DPIs 和软雾吸入器）的每日规定剂量数和总数，以及每位患者的定量吸入器数（2020 年）。第三，我们估计了如果 70%的患者从使用 pMDIs 改为使用 NPIs，那么 CO 当量的潜在减排量。第四，我们进行了预算影响分析。
荷兰呼吸保健。
当前吸入药物的碳足迹，以及用 NPIs 替代 pMDIs 的环境和财务影响。
2020 年，有 140 万患者使用吸入器治疗 COPD 或哮喘。共分发了 3.64 亿次吸入剂量，其中 49.6% 通过 pMDIs 分发。我们估计，这一比例可减少 70%，从而使温室气体年排放量减少 6300 万公斤.CO2 当量，每年最多可节省 4910 万欧元。
在荷兰，为符合条件的患者替代 pMDIs 为 NPIs 在理论上是安全的，且符合医疗指南，同时平均减少 6300 万公斤.CO2 当量的温室气体排放，每年最多可节省 4910 万欧元。本研究证实了提供更环保的呼吸护理具有潜在的气候和经济效益。
