Balancing environmental needs with respiratory healthcare

What is the interconnection between climate action and respiratory health?

Stelios: Chronic respiratory diseases are prime examples of the growing health impacts of climate change. The climate crisis is likely to cause 250,000 additional deaths per year globally between 2030 and 2050.¹ Poor air quality and extreme weather conditions pose great risks to people living with asthma and chronic obstructive pulmonary disease (COPD) and increase the number of people developing these diseases.^2,3,4 Health systems need to care for these patients, but in doing so they generate greenhouse gases, contributing to the problem.⁵

How is respiratory care generating greenhouse gas emissions?

Christer: All medicines and healthcare interactions have a carbon footprint.⁵ With chronic respiratory diseases like asthma and COPD, the carbon footprint stems from medicines use, doctor visits, and hospital care.^6,7,8 Because of this, we usually see that the better a patient’s respiratory disease is managed, the lower the associated carbon footprint of care.^6,7,8

Why is the ongoing revision of the F-gas regulation relevant to respiratory care?

Christer: Updates to the F-gas regulation could affect a key element in the wider carbon footprint of respiratory care – the use of inhaled medicines. Most people with asthma or COPD rely on pressurised metered-dose inhalers (pMDIs) to manage their disease.^9,10 pMDIs are important therapeutic options that can improve quality of life and save lives.¹¹ These inhaled medicines use a type of medical-grade F-gas to propel the medicine into a patient’s lungs.¹²  

Stelios: Overall, the EU’s revised F-gas regulation will drive a significant reduction in the use of F-gases, which are employed across many sectors, including refrigeration, air conditioning and heat pump industries, and carry global warming effects many times greater than carbon dioxide.¹³ In the case of healthcare, the medical use of F-gases currently accounts for less than 0.1% of globally reported greenhouse gas emissions.¹⁴ The healthcare sector is already working to transition the propellants used in pMDIs to low global warming potential propellants, in order to balance environmental sustainability with population health needs.

How can we balance environmental sustainability with these respiratory care needs at EU level?

Stelios: As we work to achieve the EU’s climate goals, it’s crucial this is done in a way that maintains or improves people’s quality of life and supports a healthy population. Through collaboration between policymakers, patient organisations, healthcare professionals, industry, and other relevant stakeholders, we can create healthier environments without compromising the needs of millions of people with respiratory diseases. 

As l mentioned earlier, a key element of this is the transition of existing inhaled medicines to the next generation of environmentally friendly propellants. While this is exciting, it requires continued investment in research and development, and the biopharmaceutical industry has stated a full transition is likely to take until at least 2030.¹⁵ During this period, we must guarantee that any change in the treatment of life-threatening respiratory conditions will ensure equivalent or better care for patients in the EU and beyond.

How can the respiratory community support the EU’s climate goals?

Christer: While new propellants with lower global warming potential undergo clinical and regulatory requirements, it remains important that patients have continued access to their inhaler of choice for optimal disease management and to avoid increasing the carbon footprint of care.

Switching inhaled medicines without patient consent or clinical assessment can result in poor health outcomes for respiratory patients.^16-18 Actions can also be taken to reduce inappropriate use of inhaled medicines by implementing the latest evidence-based treatment guidelines.

In the long run, our health and climate goals are aligned, as respiratory patients with well-controlled diseases usually have smaller carbon footprints than those with poorly controlled diseases.^8,19

Click here to learn more about climate change and respiratory diseases 

References

1. WHO. Climate Change and Health [Online]. Available at: Climate change and health (who.int) [Accessed February 2023].

2. Deng SZ et al. Chinese Medical Journal. 2020 Jul 5;133(13):1552-60

3. WHO. Health consequences of air pollution on populations [Online]. Available at: https://www.who.int/news/item/15-11-2019-what-are-health-consequences-of-air-pollution-on-populations. [Accessed February 2023].

4. Wu Y et al. Front Public Health. Global Burden of Respiratory Diseases Attributable to Ambient Particulate Matter Pollution: Findings From the Global Burden of Disease Study 2019. 2021;9: doi: 10.3389/fpubh.2021.

5. Tennison I, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. 2021;5(2): e84-e92.

6. Quint JK et al. Short-Acting Beta-2-Agonist Exposure and Severe Asthma Exacerbations: SABINA Findings From Europe and North America. JACI IP 2022; 10(9):2310-23118.

7. Janson C., et al. The carbon footprint of respiratory treatments in Europe and Canada: an observational study from the CARBON programme. Eur Respir J. 2022; 60:2102760.  

8. Wilkinson A. et al. Greenhouse gas emissions associated with asthma care in the UK: results from SABINA CARBON. Oral session presented at European Respiratory Society (ERS) International Congress, 2021 Sep 5-8.

9. AstraZeneca UK Ltd Data on File. ID: REF-154642. June 2022.

10. Usmani, OS. Choosing the right inhaler for your asthma or COPD patient. Therapeutics and clinical risk management. 2019:15;461-472.

11. Roche N, et al. The evolution of pressurized metered-dose inhalers from early to modern devices. J Aerosol Med Pulm Drug Deliv. 2016; 4: 311–27.

12. Myrdal PB, et al. AAPS PharmSciTech. 2014;15(2):434–455.

13. European Commission. Feedback from: International Pharmaceutical Aerosol Consortium. [Online]. Available at: [Accessed February 2023].

14. Pernigotti D, et al. Reducing carbon footprint of inhalers: analysis of climate and clinical implications of different scenarios in five European countries. BMJ open respiratory research. 2021;8(1):e001071.

15. IPAC. Position paper on the proposed revision of the EU F-Gas regulation. [Online]. Available at: https://ec.europa.eu/info/law/better-regulation/have-your-say/initiatives/12479-Fluorinated-greenhouse-gases-review-of-EU-rules-2015-20-/F3317512_en. [Accessed February 2023].

16. Usmani OS, et al. Real-world impact of non-clinical inhaler regimen switches on asthma or COPD: a systematic review. JACI: In Practice. 2022:10(10);2625-2637.

17. Doyle S, et al. What happens to patients who have their asthma device switched without their consent? Prim Care Respir J. 2010; 19 (2): 131–139.

18. Bjermer L. The Importance of continuity in inhaler device choice for asthma and chronic obstructive pulmonary. Respiration. 2014;88(4):346-52.

19. Bell, JB, et al. Greenhouse gas emissions associated with COPD care in the UK: Results from SHERLOCK CARBON poster presented at the European Respiratory Society (ERS) International Congress 5-8 September 2021, 58 (suppl 65) PA3551.

Organised and funded by AstraZeneca

Z4-51580 | Date of preparation: February 2023