Environmental benefit of patient referral to regular specialist care
Published online February 21, 2025
The climate emergency is a worldwide problem, considered by the United Nations to be ‘the defining issue of our time.’ Health care is one of the largest sources of greenhouse house gas (GHG) emissions in the public sector. Indeed, if considered a country, healthcare would be the 5th largest emitter of GHGs globally! In an effort to combat the climate emergency, countries are seeking to decarbonize their economies, and the healthcare sector has emerged as a central target for improvement. In 2020, the National Health Service (NHS; UK) launched its campaign for a Greener NHS, setting a target of net zero for GHG emissions it can control by 2040. Contributors to the complete carbon footprint of severe asthma (SA) in the UK and the impact of patient transition through different pathways on GHG emissions is largely unknown.
In a recent study, which was published in The Journal of Allergy and Clinical immunology: In Practice, Wilkinson et al. reported the results of a descriptive, open, cohort study including routinely collected medical records data from databases used in primary and secondary care in the UK. Patients included in the study had SA, defined as a validated asthma diagnosis plus treatment with a high-dose inhaled corticosteroid (ICS) and a controller medication, and were at least 12 years of age at the time of SA classification. Their aim was to quantify GHG emissions associated with SA care in the UK, by carbon source and transition across three stages, namely: SA, severe uncontrolled asthma (SUA) and/or regular specialist care (RSC). Total GHG emissions, and emissions related to medications, exacerbations, and healthcare resource utilization, were estimated overall and as patients transitioned along 5 pathways according to their pattern of transition along those three stages: (1) SA (i.e. no transition), (2) SA to SUA, (3) SA to RSC, (4) SA to RSC then SCA and (5) SA to SUA then RSC.
Total carbon dioxide equivalent for the SA population (n=93,054) was 2167 tonnes/10K patients/year. Transitioning to SUA was associated with up to 23% greater GHG emissions relative to the previous stage. This increase was mostly due to increased exacerbation- and medication-related emissions. Exacerbation-related emissions were up to 8 times greater, due mostly to hospitalizations. Medication-related emissions were up to 11% greater, mostly due to an increase in short-acting β2-agonist (SABA) prescriptions. Conversely, total GHG emissions decreased by as much as 24% for those referred to RSC. This decrease was due to decreased exacerbation- and medication-related emissions. Exacerbation-related emissions were up to 5 times lower, a consequence of reduced oral corticosteroid prescriptions, emergency department visits, and hospitalizations. Medication-related emissions were as much as 21% lower, driven by reduced prescription of both SABA and overall ICS. This study confirms the environmental cost of uncontrolled asthma across all transition patterns. The authors concluded that referral to RSC not only improves patient outcomes but also reduces GHG emissions in line with aims to reduce the health sector’s contribution to the total national carbon footprint.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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