Wilkinson Alexander J K, Maslova Ekaterina, Janson Christer, Radhakrishnan Vasanth, Quint Jennifer K, Budgen Nigel, Tran Trung N, Xu Yang, Menzies-Gow Andrew, Bell John P
Department of Respiratory Medicine, East and North Hertfordshire NHS Trust, Stevenage, UK.
BioPharmaceuticals Medical, AstraZeneca UK Ltd, Cambridge, UK.
Thorax. 2024 Feb 27;79(5):412-21. doi: 10.1136/thorax-2023-220259.
Poorly controlled asthma is associated with increased morbidity and healthcare resource utilisation (HCRU). Therefore, to quantify the environmental impact of asthma care, this retrospective, cohort, healthCARe-Based envirONmental cost of treatment (CARBON) study estimated greenhouse gas (GHG) emissions in the UK associated with the management of well-controlled versus poorly controlled asthma.
Patients with current asthma (aged ≥12 years) registered with the Clinical Practice Research Datalink (2008‒2019) were included. GHG emissions, measured as carbon dioxide equivalent (COe), were estimated for asthma-related medication use, HCRU and exacerbations during follow-up of patients with asthma classified at baseline as well-controlled (<3 short-acting β-agonist (SABA) canisters/year and no exacerbations) or poorly controlled (≥3 SABA canisters/year or ≥1 exacerbation). Excess GHG emissions due to suboptimal asthma control included ≥3 SABA canister prescriptions/year, exacerbations and any general practitioner and outpatient visits within 10 days of hospitalisation or an emergency department visit.
Of the 236 506 patients analysed, 47.3% had poorly controlled asthma at baseline. Scaled to the national level, the overall carbon footprint of asthma care in the UK was 750 540 tonnes COe/year, with poorly controlled asthma contributing excess GHG emissions of 303 874 tonnes COe/year, which is equivalent to emissions from >124 000 houses in the UK. Poorly controlled versus well-controlled asthma generated 3.1-fold higher overall and 8.1-fold higher excess per capita carbon footprint, largely SABA-induced, with smaller contributions from HCRU.
These findings suggest that addressing the high burden of poorly controlled asthma, including curbing high SABA use and its associated risk of exacerbations, may significantly alleviate asthma care-related carbon emissions.
哮喘控制不佳与发病率增加及医疗资源利用（HCRU）增多相关。因此，为量化哮喘治疗的环境影响，这项基于医疗保健的治疗环境成本回顾性队列研究（CARBON研究）估算了英国与哮喘控制良好和控制不佳的管理相关的温室气体（GHG）排放。
纳入在临床实践研究数据链注册的现患哮喘患者（年龄≥12岁，2008 - 2019年）。以二氧化碳当量（COe）衡量的温室气体排放，针对在基线时分类为控制良好（<3个短效β受体激动剂（SABA）吸入器/年且无加重发作）或控制不佳（≥3个SABA吸入器/年或≥1次加重发作）的哮喘患者随访期间的哮喘相关药物使用、HCRU及加重发作进行估算。因哮喘控制不佳导致的额外温室气体排放包括≥3个SABA吸入器处方/年、加重发作以及住院或急诊就诊后10天内的任何全科医生和门诊就诊。
在分析的236,506例患者中，47.3%在基线时哮喘控制不佳。按国家层面进行换算，英国哮喘治疗的总体碳足迹为每年750,540吨COe，哮喘控制不佳导致的额外温室气体排放为每年303,874吨COe，这相当于英国超过124,000所房屋的排放量。与哮喘控制良好相比，哮喘控制不佳产生的总体人均碳足迹高3.1倍，额外人均碳足迹高8.1倍，主要由SABA导致，HCRU的贡献较小。
这些发现表明，解决哮喘控制不佳的高负担问题，包括抑制SABA的高使用量及其相关的加重发作风险，可能会显著减轻哮喘治疗相关的碳排放。
