Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Open Respir Res. 2023 Sep;10(1). doi: 10.1136/bmjresp-2023-001716.
Climate change from greenhouse gas (GHG) emissions represents one of the greatest public health threats of our time. Inhalers (and particularly metred-dose inhalers (MDIs)) used for asthma and chronic obstructive pulmonary disease (COPD), constitute an important source of GHGs. In this analysis, we aimed to estimate the carbon footprint impact of improving three distinct aspects of respiratory care that drive avoidable inhaler use in Canada.
We used published data to estimate the prevalence of misdiagnosed disease, existing inhaler use patterns, medication class distributions, inhaler type distributions and GHGs associated with inhaler actuations, to quantify annual GHG emissions in Canada: (1) attributable to asthma and COPD misdiagnosis; (2) attributable to overuse of rescue inhalers due to suboptimally controlled symptoms; and (3) avoidable by switching 25% of patients with existing asthma and COPD to an otherwise comparable therapeutic option with a lower GHG footprint.
We identified the following avoidable annual GHG emissions: (1) ~49 100 GHG metric tons (MTs) due to misdiagnosed disease; (2) ~143 000 GHG MTs due to suboptimal symptom control; and (3) ~262 100 GHG MTs due to preferential prescription of strategies featuring MDIs over lower-GHG-emitting options (when 25% of patients are switched to lower GHG alternatives). Combined, the GHG emission reductions from bridging these gaps would be the equivalent to taking ~101 100 vehicles off the roads each year.
Our analysis shows that the carbon savings from addressing misdiagnosis and suboptimal disease control are comparable to those achievable by switching one in four patients to lower GHG-emitting therapeutic strategies. Behaviour change strategies required to achieve and sustain delivery of evidence-based real-world care are complex, but the added identified incentive of carbon footprint reduction may in itself prove to be a powerful motivator for change among providers and patients. This additional benefit can be leveraged in future behaviour change interventions.
温室气体（GHG）排放导致的气候变化是我们这个时代面临的最大公共卫生威胁之一。哮喘和慢性阻塞性肺疾病（COPD）患者使用的吸入器（特别是计量吸入器（MDI））是 GHG 的重要来源。在这项分析中，我们旨在估计改善三个不同方面的呼吸护理对减少加拿大不必要的吸入器使用的影响，以估算对碳足迹的影响。
我们使用已发表的数据来估计误诊疾病的患病率、现有的吸入器使用模式、药物类别分布、吸入器类型分布以及与吸入器操作相关的 GHG，以量化加拿大的年度 GHG 排放量：（1）归因于哮喘和 COPD 的误诊；（2）由于症状控制不佳而过度使用急救吸入器；（3）通过将现有的哮喘和 COPD 患者中的 25%转换为具有更低 GHG 足迹的其他可比治疗选择来避免。
我们确定了以下可避免的年度 GHG 排放量：（1）由于误诊疾病导致的约 49100 公吨 GHG；（2）由于症状控制不佳导致的约 143000 公吨 GHG；（3）由于优先处方具有 MDI 的策略而不是排放 GHG 较低的选择导致的约 262100 公吨 GHG（当 25%的患者转换为 GHG 较低的替代方案时）。这些差距的 GHG 减排量相当于每年减少约 101100 辆汽车上路。
我们的分析表明，解决误诊和疾病控制不佳的碳节约与将四分之一的患者转换为排放 GHG 较低的治疗策略所实现的碳节约相当。实现和维持基于证据的真实护理所需的行为改变策略很复杂，但所确定的额外激励因素——减少碳足迹本身可能证明是提供者和患者改变的有力动力。这一额外的好处可以在未来的行为改变干预中加以利用。
