Turning green: the impact of changing to more eco-friendly respiratory healthcare – a carbon and cost analysis of Dutch prescription data

Have, Pieter ten; Hal, P. van; Wichers, Iris; Kooistra, Johan; Hagedoorn, Paul; Brakema, Evelyn A; Chavannes, Niels H.; Heer, Pauline de; Ossebaard, Hans Cornelis

doi:10.1136/bmjopen-2021-055546

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Over the years, despite the availability of propellant-free devices (eg, DPIs), MDIs have remained the most widely used delivery system for short-acting relievers (>90% of inhalers sold),5 as well as for ICSs and ICS/LABAs (about half of inhalers sold), despite multiple DPI options in these classes 20. Our study expands on previous findings suggesting that switching MDIs to DPIs could offer attractive carbon savings in asthma and COPD 5 7 50 52 53. Janson et al 5 reported that switching 80% of Salbutamol MDIs to DPIs would save 550 000 MT CO 2 e annually in the UK.…”

Section: Discussionsupporting

confidence: 83%

Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis

Gagné,

Karanikas,

Green

et al. 2023

BMJ Open Resp Res

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IntroductionClimate 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.MethodsWe 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.ResultsWe 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.ConclusionsOur 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.

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Section: Discussionsupporting

confidence: 83%

Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis

Gagné,

Karanikas,

Green

et al. 2023

BMJ Open Resp Res

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“…In Japan, the reduction effect of replacement is relatively small, probably because the ratio of pMDI prescriptions is lower than that in these countries. The economic impact of replacement has also been investigated in the United Kingdom and the Netherlands, and it appears that a change to lower‐cost DPIs can result in cost reductions, while a conventional change would lead to an increase in cost 20,21 . In this study, it appears that a change to a DPI with a higher prescribing volume would lead to only a slight cost increase.…”

Section: Discussionmentioning

confidence: 73%

“…Wilkinson et al estimated that for every 10% replacement, 58 ktCO 2 e could be saved 20 . Forced replacement of inhalers throughout a country could lead to up to 76%–84% reduction in pMDI‐related GHG emissions 13,20,21 . The second strategy is to replace pMDI propellant with an eco‐friendly one.…”

Section: Introductionmentioning

confidence: 99%

The environmental impact of inhaler replacement: A carbon footprint and economic calculation of the National Database of Health Insurance Claims in Japan

Nagasaki

Kaji

Wada

et al. 2023

J of Gen and Family Med

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Background Drugs are a major source of greenhouse gas (GHG) emissions from healthcare systems. Pressurized metered‐dose inhalers (pMDIs) have raised concerns over their environmental impact due to GHG emissions. Evaluations and reduction strategies for GHGs have been primarily studied in Europe, but not in other regions, including Japan. Therefore, our objective was to calculate the carbon footprint of inhalers in Japan and evaluate their reduction scenarios. Methods Using the National Database of Health Insurance Claims, our analysis was conducted on inhaler prescriptions in Japan for the fiscal year of 2019. We calculated the number of inhalers used, GHG emissions, and total costs. Next, we simulated the environmental and economic impacts of three reduction scenarios: the first scenario replaced pMDI with dry power inhalers, followed by age‐based replacements. In the last scenario, we replaced pMDI with a propellant with a lower global warming potential. Results All inhaler‐related GHG emissions were 202 ktCO2e, of which 90.9% were attributed to pMDI use. Scenario analysis demonstrated that replacing 10% pMDI with DPI would reduce emissions by 6.7%, with a relatively modest increase in cost; substituting 10% of pMDI used by adults (excluding children and older adults) with alternative inhalers would reduce emissions by 6.1%, with a 0.7% increase in cost; and, replacing 10% of pMDI propellants with lower global warming potential would reduce emissions by 9.3%. Conclusions Selecting appropriate inhalers can mitigate GHG emissions in Japan, but its impact will be less than in other countries. Nevertheless, collaborative efforts between physicians, patients, and pharmaceutical companies are necessary to reduce GHG emissions.

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“…These range from strategies for greening healthcare systems, to promoting green prescriptions and advocating for larger engagement of communities and individuals with climate-friendly activities ( box 1 ), to the specific recommendations for respiratory clinicians on what advice to give to support their patients in mitigating the risks of climate change on their health ( box 2 ). Importantly, reduced greenhouse gas emissions may be achieved by “simple” and straightforward measures like following clinical guidelines, adherence to the respective disease action plans and a personalised medicine approach that can optimise disease control, improve inhaler technique and, for asthma (and COPD) patients, minimise short-acting β-agonist (SABA) overuse [ 72 , 73 ]. SABA overuse is not only associated with an increased risk of asthma exacerbations in both children and adults [ 74 , 75 ], but also contributes a large part of the carbon footprint of the respiratory community, due to the release of F-gases with use of SABA inhalers.…”

Section: Implications For Healthcare Providers and The Patientmentioning

confidence: 99%

Climate change and respiratory disease: clinical guidance for healthcare professionals

Andersen

Vicedo-Cabrera

Hoffmann

2023

Breathe

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Climate change is one of the major public health emergencies with already unprecedented impacts on our planet, environment and health. Climate change has already resulted in substantial increases in temperatures globally and more frequent and extreme weather in terms of heatwaves, droughts, dust storms, wildfires, rainstorms and flooding, with prolonged and altered allergen and microbial exposure as well as the introduction of new allergens to certain areas. All these exposures may have a major burden on patients with respiratory conditions, which will pose increasing challenges for respiratory clinicians and other healthcare providers. In addition, complex interactions between these different factors, along with other major environmental risk factors (e.g.air pollution), will exacerbate adverse health effects on the lung. For example, an increase in heat and sunlight in urban areas will lead to increases in ozone exposure among urban populations; effects of very high exposure to smoke and pollution from wildfires will be exacerbated by the accompanying heat and drought; and extreme precipitation events and flooding will increase exposure to humidity and mould indoors. This review aims to bring respiratory healthcare providers up to date with the newest research on the impacts of climate change on respiratory health. Respiratory clinicians and other healthcare providers need to be continually educated about the challenges of this emerging and growing public health problem and be equipped to be the key players in solutions to mitigate the impacts of climate change on patients with respiratory conditions.Educational aimsTo define climate change and describe major related environmental factors that pose a threat to patients with respiratory conditions.To provide an overview of the epidemiological evidence on climate change and respiratory diseases.To explain how climate change interacts with air pollution and other related environmental hazards to pose additional challenges for patients.To outline recommendations to protect the health of patients with respiratory conditions from climate-related environmental hazards in clinical practice.To outline recommendations to clinicians and patients with respiratory conditions on how to contribute to mitigating climate change.

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Turning green: the impact of changing to more eco-friendly respiratory healthcare – a carbon and cost analysis of Dutch prescription data

Cited by 8 publications

References 18 publications

Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis

Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis

The environmental impact of inhaler replacement: A carbon footprint and economic calculation of the National Database of Health Insurance Claims in Japan

Climate change and respiratory disease: clinical guidance for healthcare professionals

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