Managing asthma while caring for the planet
Published online July 7, 2025
If healthcare was a country, it would be the fifth largest emitter of greenhouse gases. This highlights the importance of using interventions that are simultaneously effective, safe, and environmentally friendly. Asthma is one of those conditions in which it may be possible to decrease underlying greenhouse gas emissions while at the same time achieving good disease control. In fact, asthma inhalers can differ widely in terms of their environmental impact: pressurized metered-dose inhalers (pMDI) have a higher carbon footprint than dry powder inhalers (DPI).
To evaluate how it may be possible to simultaneously consider the environmental impact and the effectiveness of different asthma treatment strategies, Vieira et al. adopted an innovative approach. In fact, in a study published in The Journal of Allergy and Clinical Immunology: In Practice, the authors obtained data (i) on the yearly greenhouse gas emissions and (ii) on the utilities (a measure of health-related quality of life) of three treatment strategies for mild asthma: as-needed budesonide/formoterol DPI, as-needed salbutamol pMDI, and maintenance budesonide DPI plus as-needed salbutamol pMDI. The authors were then able to compare the three strategies on the amount of greenhouse gas emissions per quality-adjusted life year (QALY) gained, an approach they termed “carbon-utility study.” Results were then compared with the amount of healthcare-related per capita emissions in different countries.
The authors reported that as-needed salbutamol pMDI had a higher carbon footprint and a lower effectiveness than the other treatment strategies. On the other hand, maintenance budesonide DPI plus as-needed salbutamol pMDI displayed a higher carbon footprint and a marginally higher effectiveness than as-needed budesonide/formoterol DPI. However, when simultaneously considering the environmental impact and the effectiveness of the two strategies, budesonide DPI plus as-needed salbutamol pMDI resulted in 2192 more kilograms of carbon dioxide equivalents per QALY gained than as-needed budesonide/formoterol DPI. This is higher than the amount of US per capita healthcare-related emissions. Overall, these findings indicate that, in patients with mild asthma, as-needed budesonide/formoterol DPI is the preferred option when considering both carbon emissions and treatment effectiveness.
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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