Short-acting β2-agonists and greenhouse gas emissions in Europe and Canada

Clinical Research Results Abstract Introduction: Short-acting β2-agonist (SABA) overuse (≥3 canisters/year) is associated with poor asthma outcomes. Recently, the environmental impact of inhaler choice has received much attention, but is often focused on preventers, omitting the contribution of SABAs. As part of the healthCARe-Based carbON cost of treatment (CARBON) programme, the SABA CARBON-Europe and Canada observational cohort study assessed greenhouse gas (GHG) emissions for (i) SABA vs total inhaler use (all respiratory indications) in 20 European countries and in Canada, and (ii) SABA overuse (prescription/dispensing of ≥3 canisters/year) in asthma in five European countries and two Canadian provinces (Alberta and Nova Scotia) from the SABA use IN Asthma (SABINA) programme.Methods: Inhaler use for SABA and controller medications (across all respiratory use) was analysed using sales data from IQVIA™ (09/2018−09/2019). Data were compared by dose, preventing confounding from device actuation count differences. SABA overuse in patients with asthma (aged ≥12 years) of any severity was assessed using prescription/dispensing data from SABINA (2006–2019). Annual GHG emissions (expressed as CO2 equivalent) were quantified using published1,2 and internal AstraZeneca data.3Results: Across all countries, SABA inhalers represented 29–65% of all inhaler use and accounted for 47–80% of GHG emissions from inhalers (Figure 1A). In the seven SABINA datasets, 69–94% of SABA prescriptions for asthma went to patients who were overusing SABA (≥3 canisters/year; Figure 1B). SABA overuse contributed to high per capita GHG emissions (78–864 tonnes CO2 equivalent/10,000 persons/year; Figure 1C). Discussion: SABA use commonly constitutes the majority of GHG emissions from inhalers, with overuse in asthma representing a potentially modifiable environmental impact. Implementing guidelines to drive improvements in asthma care would improve disease control, thereby reducing SABA use and additional healthcare resource use, benefiting patients and realising carbon savings that go beyond the reduction in SABA use alone. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest The study was designed and funded by AstraZeneca. IQVIA™ did not provide any support for the analysis or interpretation of the data. References and Clinical Trial Registry Information Janson, C. et al. Carbon footprint impact of the choice of inhalers for asthma and COPD. Thorax 75, 82-84 (2020). doi: 10.1136/thoraxjnl-2019-214381 Jeswani H. K. & Azapagic, A. J Cleaner Prod 237, 117733 (2019). doi: 10.1016/j.jclepro.2019.117733AstraZeneca ERM LCA Internal Reports. (2021)