The carbon footprint of as-needed budesonide/formoterol in mild asthma: a post hoc analysis

The carbon footprint of as-needed budesonide/formoterol in mild asthma: a post hoc analysis. Hatter, L., Holliday, M., Eathorne, A., Bruce, P., Pavord, I. D., Reddel, H. K., Hancox, R. J., Papi, A., Weatherall, M., & Beasley, R. European Respiratory Journal, 64(1):2301705, July, 2024.

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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\textless0.001) 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\textless0.001), 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.

@article{hatter_carbon_2024,
	title = {The carbon footprint of as-needed budesonide/formoterol in mild asthma: a \textit{post hoc} analysis},
	volume = {64},
	issn = {0903-1936, 1399-3003},
	shorttitle = {The carbon footprint of as-needed budesonide/formoterol in mild asthma},
	url = {http://erj.ersjournals.com/lookup/doi/10.1183/13993003.01705-2023},
	doi = {10.1183/13993003.01705-2023},
	abstract = {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{\textless}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{\textless}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.},
	language = {en},
	number = {1},
	urldate = {2024-08-11},
	journal = {European Respiratory Journal},
	author = {Hatter, Lee and Holliday, Mark and Eathorne, Allie and Bruce, Pepa and Pavord, Ian D. and Reddel, Helen K. and Hancox, Robert J. and Papi, Alberto and Weatherall, Mark and Beasley, Richard},
	month = jul,
	year = {2024},
	pages = {2301705},
}

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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. 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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. \n \n \n Methods \n \n This \n post hoc \n 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 \n 2 \n e) per person-year. 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