Recommendations for Reducing the Environmental Impact of Inhalers in Portugal: Consensus Document

Authors

  • Luí­s Campos Hospital CUF Tejo. Lisboa; Conselho Português para a Saúde e Ambiente. Lisboa.
  • Paula Rosa Serviço de Pneumologia. Hospital de Vila Franca de Xira Unidade Local de Saúde Estuário do Tejo. Vila Franca de Xira; Hospital CUF Descobertas. Lisboa; Sociedade Portuguesa de Pneumologia. Lisboa.
  • Pedro Carreiro Martins Serviço de Imunoalergologia. Hospital Dona Estefânia. Unidade Local de Saúde São José. Lisboa; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa; Sociedade Portuguesa de Alergologia e Imunologia Clínica. Lisboa.
  • Bilhota Xavier Sociedade Portuguesa de Pediatria. Lisboa; Secção Pediátrica da Qualidade e Segurança. Sociedade Portuguesa de Pediatria. Lisboa.
  • Pedro Leuschner Serviço de Medicina Interna. Centro Hospitalar Universitário de Santo António. Porto; Instituto de Ciência Biomédicas Abel Salazar. Porto; Sociedade Portuguesa de Medicina Interna. Lisboa.
  • Maria Inês M. Marques Unidade de Saúde Familiar Reynaldo dos Santos. Unidade Local de Saúde Estuário do Tejo. Vila Franca de Xira; Associação Portuguesa de Medicina Geral e Familiar. Lisboa.
  • José Albino Associação Respira. Lisboa.
  • Carlos Robalo Cordeiro Sociedade Portuguesa de Pneumologia. Lisboa; Serviço de Pneumologia. Centro Hospitalar Universitário de Coimbra. Unidade Local de Saúde de Coimbra. Coimbra; Faculdade de Medicina. Universidade de Coimbra. Coimbra. 

DOI:

https://doi.org/10.20344/amp.22062

Keywords:

Administration, Inhalation, Carbon Footprint, Dry Powder Inhalers, Greenhouse Gases, Metered Dose Inhalers, Nebulizers and Vaporizers, Portugal

Abstract

This consensus document addresses the reduction of the environmental impact of inhalers in Portugal. It was prepared by the Portuguese Council for Health and the Environment and the societies representing the specialties that account for these drugs’ largest volume of prescriptions, namely the Portuguese Society of Pulmonology, the Portuguese Society of Allergology and Clinical Immunology, the Portuguese Society of Pediatrics, the Portuguese Society of Internal Medicine, the Portuguese Association of General and Family Medicine and also a patient association, the Respira Association. The document acknowledges the significant impact of pressurized metered-dose inhalers on greenhouse gas emissions and highlights the need to transition to more sustainable alternatives. The carbon footprint of pressurized metered-dose inhalers and dry powder inhalers in Portugal was calculated, and the level of awareness among prescribing physicians on this topic was also estimated. Finally, recommendations were developed to accelerate the reduction of the ecological footprint of inhalers.

Downloads

Download data is not yet available.

References

United Nations. The human right to a clean, healthy and sustainable environment: draft resolution. 2022. [consultado 2024 mai 16]. Disponível em: https://digitallibrary.un.org/record/3982508?ln=en&v=pdf.

World Health Organization. Climate change and health. [consultado 2024 mai 16]. Disponível em: https://www.who.int/news-room/factsheets/ detail/climate-change-and-health.

Ribeiro HR. Poluição, um veneno silencioso para a saúde humana. Rev Ciência Elem. 2019;7:1-5.

United States Environmental Protection Agency. Climate impacts on human health. [consultado 2024 mai 18]. Disponível em: https://19january2017snapshot.epa.gov/climate-impacts/climateimpacts- human-health_.html.

Health Care Without Harm. Health care’s climate footprint. 2019. [consultado 2024 mai 16]. Disponível em: https:// noharm-global.org/sites/default/files/documents-files/5961/ HealthCaresClimateFootprint_092319.pdf.

Wilkinson AJ, Braggins R, Steinbach I, Smith J. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open. 2019;9:e028763.

Jornal Oficial da União Europeia. Regulamento (UE) 2024/573 do Parlamento Europeu e do Conselho, de 7 de fevereiro de 2024, relativo aos gases fluorados com efeito de estufa, que altera a Diretiva (UE) 2019/1937 e que revoga o Regulamento (UE) n.º 517/2014. 2024. [consultado 2024 mai 19]. Disponível em: https://eur-lex.europa.eu/ legal-content/PT/TXT/PDF/?uri=OJ:L_202400573.

Keeley D, Scullion JE, Usmani OS. Minimising the environmental impact of inhaled therapies: problems with policy on low carbon inhalers. Eur Respir J. 2020;55:2000048.

Khan N, Walpole SC, Rostkowska OM, Smith JN, Miller FA. Do clinical practice guidelines follow sustainable healthcare principles? A review of respiratory guidance. PLOS Sustain Transform. 2023;2:e0000078.

Usmani OS, Levy ML. Effective respiratory management of asthma and COPD and the environmental impacts of inhalers. NPJ Prim Care Respir Med. 2023;33:24.

Woodcock A, Beeh KM, Sagara H, Aumônier S, Addo-Yobo E, Khan J, et al. The environmental impact of inhaled therapy: making informed treatment choices. Eur Respir J. 2022;60:2102106.

Wilkinson A, Woodcock A. The environmental impact of inhalers for asthma: a green challenge and a golden opportunity. Br J Clin Pharmacol. 2022;88:3016-22.

Alzaabi A, Bell JP, Montero-Arias F, Preço DB, Jackson DJ, Hao-Chien W, et al. Greenhouse gas emissions from respiratory treatments: results from the SABA CARBON International Study. Adv Ther. 2023;40:4836- 56.

Jeswani HK, Azapagic A. Life cycle environmental impacts of inhalers. J Clean Prod. 2019;237:117733.

Novartis. Case study: Breezhaler® Carbon Footprint. [consultado 2024 mai 21]. Disponível em: https://www.novartis.com/esg/environmentalsustainability/ climate/case-study-breezhaler-carbon-footprint.

Panigone S, Sandri F, Ferri R, Volpato A, Nudo E, Nicolini G. Environmental impact of inhalers for respiratory diseases: decreasing the carbon footprint while preserving patient-tailored treatment. BMJ Open Respir Res. 2020;7:e000571.

Borenius K, Vartiainen V, Takala A, Haikarainen J, Parker G, Paronen N, et al. Life cycle assessment (LCA) and cradle-to-grave (CTG) carbon footprint of a multidose reservoir dry powder inhaler. Sheffield: European Respiratory Society; 2020.

Hänsel M, Bambach T, Wachtel H. Reduced environmental impact of the Reusable Respimat® Soft MistTM inhaler compared with pressurised metered-dose inhalers. Adv Ther. 2019;36:2487-92.

Janson C, Henderson R, Löfdahl M, Hedberg M, Sharma R, Wilkinson AJK, et al. Carbon footprint impact of the choice of inhalers for asthma and COPD. Thorax. 2020:75:82-4.

National Institute for Health and Care Excellence. Asthma inhalers and climate change. [consultado 2024 mai 20]. Disponível em: https:// www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patientdecision- aid-pdf-6727144573.

Smith J, Bansal A, Barron-Snowdon J, Keeley D, Wilkinson A. How to reduce the carbon footprint of inhaler prescribing. [consultado 2024 mai 20]. Disponível em: https://s40639.pcdn.co/wp-content/uploads/ Reducing-Carbon-Footprint-of-Inhaler-Prescribing-v3.3.2.pdf.

PrescQIPP. Bulletin 295: inhaler carbon footprint. [consultado 2024 mai 20]. Disponível em: https://www.prescqipp.info/our-resources/bulletins/ bulletin-295-inhaler-carbon-footprint/.

NHS Business Services Authority. Respiratory - carbon impact dashboard [consultado 2024 mai 28]. Disponível em: https://www. nhsbsa.nhs.uk/access-our-data-products/epact2/dashboards-andspecifications/ respiratory-carbon-impact-dashboard.

Fulford B, Mezzi K, Aumônier S, Finkbeiner M. Carbon footprints and life cycle assessments of inhalers: a review of published evidence. Sustainability. 2022;14:7106.

Woodcock A, Janson C, Rees J, Frith L, Löfdahl M, Moore A, et al. Effects of switching from a metered dose inhaler to a dry powder inhaler on climate emissions and asthma control: post-hoc analysis. Thorax. 2022;77:1187-92.

Beeh KM, Kuna P, Corradi M, Viaud I, Guasconi A, Georges G. Comparison of dry-powder inhaler and pressurized metered-dose inhaler formulations of extrafine beclomethasone dipropionate/formoterol fumarate/glycopyrronium in patients with COPD: the tri-d randomized controlled trial. Int J Chron Obstruct Pulmon Dis. 2021;16:79-89.

PrescQIPP. Bulletin 295 - inhaler carbon footprint. [consultado 2024 mai 22]. Disponível em: https://www.prescqipp.info/our-resources/bulletins/ bulletin-295-inhaler-carbon-footprint/.

Ramadan WH, Sarkis AT. Patterns of use of dry powder inhalers versus pressurized metered-dose inhalers devices in adult patients with chronic obstructive pulmonary disease or asthma: an observational comparative study. Chron Respir Dis. 2017;14:309-20.

Campos L, Barreto JV, Bassetti S, Bivol M, Burbridge A, Castellino P, et al. Physicians’ responsibility toward environmental degradation and climate change: a position paper of the European Federation of Internal Medicine. Eur J Intern Med. 2022;104:55-8. 30. Campos L, Chimeno-Viñas MM, Carretero-Gómez J, Santos L, Cabrera- Rayo A, Valdez PR, et al. Recommendations of the Spanish-Portuguese internal medicine services in the fight against climate change and environmental degradation. Rev Clín Esp. 2024;224:162-6.

Published

2024-09-02

How to Cite

1.
Campos L, Rosa P, Carreiro Martins P, Xavier B, Leuschner P, M. Marques MI, Albino J, Robalo Cordeiro C. Recommendations for Reducing the Environmental Impact of Inhalers in Portugal: Consensus Document. Acta Med Port [Internet]. 2024 Sep. 2 [cited 2024 Sep. 8];37(9):654-61. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/22062

Issue

Section

Guidelines