Introduction: The use of pressurised metered-dose inhalers (pMDIs) and asthma exacerbations necessitating healthcare reviews contribute substantially to the global carbon footprint of healthcare. It is possible that a reduction in carbon footprint could be achieved by switching patients with mild asthma from salbutamol pMDI reliever-based therapy to inhaled corticosteroid-formoterol dry powder inhaler (DPI) reliever therapy, as recommended by the Global Initiative for Asthma.
Methods: This post hoc analysis included all 668 adult participants in the Novel START trial, who were randomised 1:1:1 to treatment with as-needed budesonide/formoterol DPI, as-needed salbutamol pMDI or maintenance budesonide DPI plus as-needed salbutamol pMDI. The primary outcome was carbon footprint of asthma management, expressed as kilograms of carbon dioxide equivalent emissions (kgCO
2 e) per person-year. Secondary outcomes explored the effect of baseline symptom control and adherence (maintenance budesonide DPI arm only) on carbon footprint.
Results: As-needed budesonide/formoterol DPI was associated with 95.8% and 93.6% lower carbon footprint compared with as-needed salbutamol pMDI (least-squares mean 1.1 versus 26.2 kgCO
2 e; difference -25.0, 95% CI -29.7 to -20.4; p<0.001) and maintenance budesonide DPI plus as-needed salbutamol pMDI (least-squares mean 1.1 versus 17.3 kgCO
2 e; difference -16.2, 95% CI -20.9 to -11.6; p<0.001), respectively. There was no statistically significant evidence that treatment differences in carbon footprint depended on baseline symptom control or adherence in the maintenance budesonide DPI arm.
Conclusions: The as-needed budesonide/formoterol DPI treatment option was associated with a markedly lower carbon footprint than as-needed salbutamol pMDI and maintenance budesonide DPI plus as-needed salbutamol pMDI.
Competing Interests: Conflict of interest: I.D. Pavord reports grants from Chiesi and Merck, lecture honoraria from AstraZeneca, Boehringer Ingelheim, Aerocrine, Almirall, Novartis, Teva, Chiesi, Sanofi/Regeneron, Menarini and GSK, payment for expert testimony from AstraZeneca and Teva, travel support from GSK, Boehringer Ingelheim, AstraZeneca, Teva and Chiesi, patents from Merck, Bayer and Insmed, and advisory board participation with Genentech, Sanofi/Regeneron, AstraZeneca, Boehringer Ingelheim, GSK, Novartis, Teva, Merck, Circassia, Chiesi and Knopp. H.K. Reddel reports grants from AstraZeneca, GlaxoSmithKline and Perpetual Philanthropy, consulting fees from Novartis, AstraZeneca and GlaxoSmithKline, lecture honoraria from AstraZeneca, GlaxoSmithKline, Teva, Boehringer Ingelheim, Sanofi, Getz, Chiesi and Alkem, advisory board participation for AstraZeneca, GlaxoSmithKline, Novartis, Chiesi and Sanofi, and is chair of the Science Committee and member of the Board of Directors of the Global Initiative for Asthma, and member of the Australian Asthma Guidelines Committee. R.J. Hancox reports funding for the present manuscript from AstraZeneca, and reports an unpaid leadership role with Asthma Foundation of New Zealand. A. Papi reports grants from Chiesi, AstraZeneca, GlaxoSmithKline and Sanofi, consulting fees from Chiesi, AstraZeneca, GlaxoSmithKline, Novartis, Sanofi, Iqvia, Avillion, Elpen Pharmaceuticals and Moderna, lecture honoraria from Chiesi, AstraZeneca, GlaxoSmithKline, Menarini, Zambon, Mundipharma, Sanofi, Edmond Pharma, Iqvia, MSD and Avillion, and advisory board participation with Chiesi, AstraZeneca, GlaxoSmithKline, Novartis, Sanofi, Iqvia, Avillion, Elpen Pharmaceuticals and Moderna, outside the submitted work. R. Beasley reports support for the present manuscript from AstraZeneca and Health Research Council (NZ). In addition, outside the submitted work, R. Beasley reports grants from AstraZeneca, Genentech, HRC (NZ) and Cure Kids NZ, lecture honoraria and travel support from AstraZeneca, Avillion, Cipla, Teva and CSL Seqirus, leadership roles as chair of NZ asthma guidelines and board member of GOLD, and receipt of equipment from AstraZeneca. The remaining authors have no potential conflicts of interest to disclose.
(Copyright ©The authors 2024. For reproduction rights and permissions contact
[email protected].)
Processing Request
No Comments.