Can we minimize carbon footprint by using "greener" inhalers and improve clinical outcome at the same time in asthma therapy?

The treatment of patients with obstructive airway diseases is based on the use of inhalation preparations. Some of them, mainly including pressurized metered dose inhalers (pMDIs), contain compressed gases - hydrofluoroalkanes, which generate carbon dioxide emissions, creating the so-called carbon footprint. AIM The aim of the study was to evaluate the consumption of individual active substances, the types of inhalers used and calculation of the carbon footprint of therapies in patients with asthma in 2018 and 2019 in Poland. MATERIALS AND METHODS The ratio of pMDI vs DPI (dry powder inhaler) data and the data on using in patients with asthma long-acting β2-agonists (LABAs), short-acting β2-agonists antagonists (SABAs), long-acting muscarinic antagonists (LAMAs), LAMA+LABAs, LAMA+LABA+ICSs (inhaled corticosteroids) on Polish market during 2018 and 2019 were analyzed. The carbon footprint of such therapies was counted. Then, we studied the reduction of the carbon footprint for scenario A (reducing pMDI by 50%) and scenario B (reducing pMDI by 80%) in the following steps of analysis. RESULTS The general structure of pMDI/DPI in Poland in asthma patients was not changed in 2019 vs 2018. The carbon footprint is primarily created by pMDI SABAs. In 2019 in Poland pMDI SABAs were 1.9 mio units (the same as in 2018), which generated 36.8 kt CO2e annually. Scenario A gives us a benefit of 17.4 kt CO2e reduction and scenario B brings us a benefit of 28.0 kt CO2e reduction of emissions. CONCLUSIONS Despite Poland's ratification the Kigali amendment did not affect pMDI consumption by asthma patients and did not reduce the carbon footprint. The lower carbon footprint of DPIs should be considered alongside other factors when choosing inhalation devices.