Is respiratory care carbon conscious? Rationale and future implications for the CARBON respiratory program

Abstract

BACKGROUND AND AIM: Healthcare systems need to substantially reduce greenhouse gas (GHG) emissions as societies decarbonize their economies. In respiratory medicine, contributions from healthcare resource utilization (HCRU) and short-acting β₂-agonist (SABA) relievers, which provide rapid relief from asthma symptoms, are significant. SABA relievers contribute to the majority of inhaler usage and total carbon footprint of inhaler devices across Europe. In asthma, high SABA use is common and associated with poor disease control and increased exacerbation risk.¹ In chronic obstructive pulmonary disease (COPD), exacerbation history is linked with increased rate of future exacerbations;² both SABA use and exacerbations increase HCRU requirements. Here, we provide an overview of the healthCARe-Based carbON cost of treatment (CARBON) sustainability program, which evaluates the carbon footprint associated with poorly and well-managed care of common respiratory diseases. METHODS: CARBON is the first program to quantify the carbon footprint of HCRU and medications in respiratory healthcare by using a combination of certified published studies and methodologies. RESULTS:Patients with well-managed asthma and COPD are likely to have a lower carbon impact through reduced requirements for SABA medication use and HCRU. This CARBON group of studies is evaluating the overall carbon footprint associated with SABA use, exacerbations, and HCRU in over 1.5 million patients with asthma or COPD in over 30 European and North American countries. CONCLUSIONS:Understanding what comprises the carbon footprint of respiratory healthcare and how it is impacted by poor disease control or disease progression is the first step in understanding how innovative treatments and guideline implementation can drive carbon reduction without risking improvements in patient outcomes. The principle of evidence-led care improvement as a means to achieve greater sustainability will have multiple benefits for patients and society.