Carbon footprint of inhalers in respiratory treatment: SABA CARBON International

Abstract

<b>Background:</b> The environmental impact of preventer inhalers has been a recent focus in respiratory care, despite widespread SABA overuse (≥3 canisters/year) and associated poor outcomes. <b>Aim:</b> To assess greenhouse gas (GHG) emissions for SABA vs total inhaler use (all respiratory indications), and SABA overuse for asthma, in Africa, Asia-Pacific, Latin America, and the Middle East as part of the CARBON programme. <b>Methods:</b> This observational study used IQVIA™ sales data (2018–2019) for inhalers (all respiratory conditions) and SABINA III SABA prescription/ OTC purchase data for asthma (2019–2020) (Bateman ED, et al. <i>ERJ</i> 2021:2101402). GHG emissions as CO₂ equivalents (CO₂e) per actuation or canister were used for calculations. <b>Results:</b> SABAs accounted for ≥50% of inhaler sales in 22/28 countries and inhaler-related GHG emissions in 24/28 countries (&gt;70% in 19/28 countries). Across geographic regions and economies, &gt;85% of SABA was prescribed to overusers. Per capita GHG emissions linked to SABA overuse were 866 and 732 tonnes CO₂e/10,000 persons/year, with and without SABA OTC, respectively. <b>Conclusion:</b> SABA comprises most of the inhaler use and inhaler-related GHG emissions, with overuse in asthma representing a potentially modifiable environmental impact. Implementing current treatment recommendations could improve disease control, reducing SABA overuse and HCRU and benefiting both patients and the environment.