Respiratory Medicine Division, Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
BioPharmaceutical Medical, Medical Affairs Respiratory and Immunology, AstraZeneca, Baar, Switzerland.
Adv Ther. 2023 Nov;40(11):4836-4856. doi: 10.1007/s12325-023-02663-2. Epub 2023 Sep 9.
Healthcare systems are looking to reduce their carbon impact. Short-acting β-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.
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.
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.
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.
医疗保健系统正在努力减少其碳足迹。短效 β-激动剂（SABA）的过度使用（≥ 3 罐/年）在哮喘中很常见，并且与不良结果有关；然而，其环境影响仍不清楚。作为 CARBON 计划的一部分，本研究回顾性地量化了中低收入国家（LMICs）、中上收入国家和高收入国家中所有呼吸系统适应症和哮喘中 SABA 过度使用的 SABA 和控制器吸入器的碳足迹在非洲、亚太地区、拉丁美洲和中东。
利用两种数据源评估吸入器对呼吸护理的碳贡献。为了量化与所有呼吸系统适应症的总吸入器使用相关的温室气体（GHG）排放，从 IQVIA MIDAS（2018 年第四季度至 2019 年第三季度）获得吸入器销售数据，并按剂量进行比较，以防止因罐式驱动计数的差异而产生混杂。使用 SABA 使用在哮喘中的 IN Asthma（SABINA）III 研究（2019-2020 年）的处方和自我报告的非处方购买数据评估哮喘中 SABA 过度使用相关的 GHG 排放。使用已发表的数据和产品生命周期评估来量化与吸入器相关的 GHG 排放。
SABA 在大多数分析的国家中占总吸入器使用和吸入器相关排放的 50%以上。总 SABA 相关排放量估计为 270 万吨二氧化碳当量，占总吸入器相关排放量的 70%。在所分析的国家、地区和经济体中，澳大利亚、中东和高收入国家的人均 SABA 使用量和相关排放量较高。超过 90%的哮喘 SABA 处方是给已经过度使用 SABA 的患者开的。
在全球范围内，SABA 的使用/过度使用非常普遍，是呼吸系统治疗碳足迹的最大贡献者，无论国家的经济状况如何。实施基于证据的治疗建议、个性化治疗和减少医疗保健不平等，特别是在 LMICs 中，可能会改善疾病控制和患者结果，从而减少 SABA 过度使用和相关的碳排放，而不仅仅是 SABA 的使用。
