ORIGINALLY PUBLISHED
8 September 2023
Written by:
Pablo Panella
Senior Vice President, Global Respiratory & Immunology, AstraZeneca
Climate change is recognised as the biggest public health crisis of our time.1 The World Health Organization (WHO) estimates that air pollution alone causes seven million premature deaths each year and heat-related deaths are expected to treble by 2050.1,2
Chronic respiratory diseases are prime examples of the growing health impacts of climate change. Poor air quality and extreme weather conditions pose great risks to people living with asthma and chronic obstructive pulmonary disease (COPD) and increase the number of people developing these diseases.2
With all medicines and healthcare interactions contributing to greenhouse gas (GHG) emissions,3 everyone in the delivery of healthcare has a role to play in decarbonising health systems. In fact, healthcare's climate footprint is 4.4% of the global total; meaning if it were a country, it would be the fifth largest emitter on the planet.4
Improving patient outcomes and reducing the carbon footprint of respiratory care
At AstraZeneca, l work with a team dedicated to discovering and developing respiratory medicines that improve outcomes for patients, while being deeply committed to lowering the environmental burden of respiratory care. Chronic respiratory diseases, including asthma and COPD, are complex, difficult to treat and often poorly controlled, which is associated with a higher carbon footprint.3 This carbon footprint stems from medicines use, doctor visits and hospital care – the time patients spend in hospital being a major driver of healthcare emissions.5 With nearly 550 million people globally living with respiratory diseases and prevalence rising, the potential associated carbon footprint is significant.6
Early detection, diagnosis and disease control to avoid exacerbations are therefore some of the most powerful ways to reduce overall healthcare resource utilisation and hospitalisations, and thus also the carbon footprint of care.3 Adoption of evidence-based treatment strategies and guideline implementation that prioritises respiratory disease control and reduces exacerbations is critical to achieving this; this also presents a solution to decision-makers seeking to decarbonise healthcare.
Delivering respiratory care differently
Alongside efforts to improve outcomes for patients, another key element to decarbonising respiratory care is the transition to climate-friendly inhaled medicines. These medicines, including pressurised metered-dose inhalers (pMDIs), are essential options for respiratory patients worldwide.7,8,9
While pMDIs contribute less than 0.1% of global GHG emissions,3 we nonetheless believe it is critical to significantly reduce this burden. In fact, at AstraZeneca, work to reduce the carbon footprint of our pMDIs is already underway and represents an important step towards achieving our Ambition Zero Carbon goal.10
We are accelerating the development of our next-generation respiratory inhalers using a propellant with near-zero Global Warming Potential10 (similar to that of dry powder inhalers), that is also non-persistent (breaks down easily in the environment)11 and non-bio accumulative12 (does not build up within living organisms). A practical transition to climate-friendly propellants is important to ensure continuity of patient care and maintain access to essential medicines that can be life-saving. With first launches of these medicines anticipated from 2025,13 these factors should be considered in any climate policy development.
Overall, collaboration among governments, policymakers and the global respiratory community will be key to delivering sustainable and life-saving healthcare practices in respiratory care, which continue to meet patient, public health and environmental needs.
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References
1. WHO. Climate change and health. [Online]. Available at:https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health. [Accessed August 2023]
2. WHO. Ambient (outdoor) air pollution. [Online]. Available at: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health. [Accessed August 2023]
3. Wilkinson A. et al. Greenhouse gas emissions associated with asthma care in the UK: results from SABINA CARBON. Oral session presented at the 10th International Primary Care Respiratory Group (IPCRG) World Conference, 2021 May 6-8; Dublin, Ireland.
4. ARUP. Health care’s climate footprint. [Online]. Available at: https://www.arup.com/perspectives/publications/research/section/healthcares-climate-footprint. [Accessed August 2023]
5. SMI. Decarbonising patient care pathways. [Online]. Available at: https://a.storyblok.com/f/109506/x/88fe7ea368/smi-hstf-pcp-whitepaper.pdf. [Accessed August 2023]
6. Wu Y et al. Front Public Health. Global Burden of Respiratory Diseases Attributable to Ambient Particulate Matter Pollution: Findings From the Global Burden of Disease Study 2019. 2021;9: doi: 10.3389/fpubh.2021.
7. Usmani OS, et al. Real-world impact of non-clinical inhaler regimen switches on asthma or COPD: a systematic review. JACI: In Practice. 2022:10(10);2625-2637.
8. Doyle S, et al. What happens to patients who have their asthma device switched without their consent? Prim Care Respir J. 2010; 19 (2): 131–139.
9. Bjermer L. The Importance of continuity in inhaler device choice for asthma and chronic obstructive pulmonary. Respiration. 2014;88(4):346-52.
10. AstraZeneca. AstraZeneca progresses Ambition Zero Carbon programme with Honeywell partnership to develop next- generation respiratory inhalers. Available at: AstraZeneca progresses Ambition Zero Carbon programme with Honeywell partnership to develop next-generation respiratory inhalers. [Accessed August 2023]
11. Wallington TJ, Sulbaek Andersen MP, Nielsen OJ. Atmospheric chemistry of short-chain haloolefins: photochemical ozone creation potentials (POCPs), global warming potentials (GWPs), and ozone depletion potentials (ODPs). Chemosphere. 2015;129:135-141.
12. ECHA Dossier - 1-Propene, 1,3,3,3-tetrafluoro-. Available at: https://echa.europa.eu/registration-dossier/-/registered- dossier/31292/2/3. [Accessed August 2023]
13. A Study to Assess How Much Drug Reaches the Blood When Given From Symbicort pMDI With Spacer Compared to That of Symbicort pMDI Without Spacer in Healthy Volunteers. Available at: https://clinicaltrials.gov/ct2/show/NCT02934607. [Accessed August 2023]
Veeva ID: Z4-59297
Date of preparation: October 2023