Protecting our environment, public health and respiratory patients

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The global health community is in a period of intense research and innovation to address the world’s most pressing environmental challenges. We are particularly focused on respiratory health. Our health is undoubtedly tied to the air we breathe and the health of the planet.[1]

The climate crisis, pollution and other environmental factors are contributing to the burden of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD).[2] At the same time, like almost all health services, caring for millions of people with these conditions has environmental impacts.[3] We need to pursue two important goals in parallel: protecting the environment and protecting health care for people with respiratory diseases. This is an increasingly important consideration for policy makers implementing important environmental legislation in Europe.

For example, the decision of the EU co-legislators to phase out fluorinated greenhouse gases (F-gases) by 2050 and perfluoroalkyl substances through REACH (Registration, Evaluation, Authorization and Restriction of Chemicals) and proposed bans on polyfluoroalkyl substances (PFAS). This regulation aims to achieve significant progress towards the EU’s green agenda, climate action and the future of global health.[4],[5] However, discussions among policy makers and stakeholders indicate the need to be mindful of unintended effects on individual health.[6] This also includes the potential unintended consequences of such legislation, particularly when it comes to inhaled drugs.

Many inhaled respiratory drugs fall within the scope of such legislation, particularly because of the propellants used to facilitate delivery of the drug to the patient’s lungs.[6] We must work across sectors to protect the health of patients who depend on these essential medicines. As we have seen with the F-gas regulation, this includes legislation that will enable the completion of regulatory reviews and support the availability and safe transition of greener versions of current standard of care drugs using next-generation propellants. and schedule. – Zero global warming potential.

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Although the environmental impact of a particular treatment is worth considering, it is important to note that simply switching respiratory patients to an alternative drug is not a viable option.a Various inhalers are currently available, each with its own characteristics. There is no universal, ideal inhaler that fits all patients. Each patient has unique abilities, skills, and preferences that must be considered individually to personalize the choice of inhaler and provide appropriate education on how to use it. .[6],[7],[8] Indeed, abrupt switches can pose personal health risks and increase the carbon footprint of treatments associated with poorly managed diseases.[6],[8],[9],[10]

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A new consensus* presented by respiratory experts at the European Respiratory Society International Conference states that switching inhalers should be done only after consulting with the patient about symptoms, disease management, and ability to use the device, and by a trained healthcare provider. It is stated that this should be done only by those who and selection of preferred regimen.[10] When a patient is able and willing to use multiple types of devices appropriately and maintains a high quality of care; Of course, you should choose the most environmentally friendly one.

Rather than systematically switching all patients to a particular type of inhaler, we should turn to one of the most effective tools already available today to reduce the environmental burden of respiratory care. It is the implementation of evidence-based treatment guidelines and quality standards to support the best possible care. Individualized care is available for people with illnesses such as asthma and COPD. The better a patient’s disease is managed, the better their health and quality of life will be, the less emergency care and other hospital services will be needed, and the less environmental impact there will be.[6],[8]

When it comes to prioritizing patient outcomes and promoting a greener agenda, both are achievable in respiratory care. The most environmentally friendly situation is when the patient knows how to properly use the inhaler and the disease is well controlled.

Mr. Roche

Nicolas Roche is Professor of Respiratory Medicine at Paris Cité University and Director of Respiratory Medicine at APHP Center Cochin Hospital in Paris, France.

*This consensus was organized and funded by AstraZeneca and is comprised of eight experts from around the world.​​​​​

The authors did not receive payment for their participation in this article. Over the past several years, Nicolas Roche or his laboratory has received payments and/or research funding or fees from companies, including AstraZeneca.


[3] J. Karliner et al. Health care’s impact on climate change: The health sector’s contribution and opportunities for action. European Journal of Public Health. 2020; 30(5):2020-01.

[6] Levy ML, Bateman ED, Allan K, et al. Global access and patient safety in the transition to environmentally friendly respiratory inhalers: A perspective from the Global Initiative for Asthma. [published online ahead of print, 2023 Jul 19]. Lancet. 2023;S0140-6736(23)01358-2.

[7] Usmani OS. Choose the right inhaler for your asthma or COPD patient. Clean risk management. 2019;15:461-472.

[8] Usmani OS, Levy ML. Effective respiratory management of asthma and her COPD and the environmental impact of inhalers. NPJ Primcare Respir Med. 2023;33(1):24.

[9] Bjermer L. The importance of continuity in inhaler selection for asthma and chronic obstructive pulmonary disease. Breathing. 2014;88(4):346-352.

[10] Usmani et al. Consensus quality standards for implementing inhalation regimen switching in patients with respiratory disease. European Respiratory Society Conference 2023. Poster number PA4607.

Sponsored and funded by AstraZeneca



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