BACKGROUND: The main types of commercially available inhalers for the management of asthma include dry powder inhalers (DPIs) and pressurized metered-dose inhalers (pMDIs). The environmental impact of pMDIs, due to hydrofluorocarbon propellants, is a growing concern. OBJECTIVE: To conduct a carbon-utility analysis in mild asthma, comparing the clinical efficacy of DPIs versus pMDIs alongside their associated environmental impacts. METHODS: We performed a carbon-utility analysis using data from the Novel START trial, comparing 3 treatment strategies for mild asthma: as-needed budesonide/formoterol DPI, as needed salbutamol pMDI, and maintenance budesonide DPI plus as-needed salbutamol pMDI. We calculated carbon dioxide equivalent (kgCO2e) emissions per quality-adjusted life year (QALY) gained. Results were compared to predefined willingness-to-emit thresholds based on health care CO2e emissions in the United States, the European Union, and the United Kingdom. RESULTS: As-needed budesonide/formoterol DPI had a yearly carbon footprint of 1.1 kgCO2e and a utility of 0.936, compared with 26.2 kgCO2e and 0.935 for as-needed salbutamol pMDI, and 17.3 kgCO2e and 0.944 for maintenance budesonide DPI plus as-needed salbutamol pMDI. Compared with budesonide/formoterol, budesonide plus salbutamol resulted in 2192 more kgCO2e per QALY gained, exceeding the US per capita kgCO2e emissions in the health care sector and its 2030 target values. As-needed salbutamol was associated with higher CO2e emissions and lower utilities than budesonide/ formoterol. CONCLUSION: We applied to the asthma field a novel methodological approach to consider both the environmental impact and effectiveness of interventions. These findings indicate that as-needed budesonide/formoterol DPI is the preferred option when considering both carbon emissions and treatment effectiveness. (c) 2025 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2025;13:2649-56)
Comparison of Three Treatment Strategies in Mild Asthma: A Carbon-Utility Analysis
Schunemann, Holger J.;
2025-01-01
Abstract
BACKGROUND: The main types of commercially available inhalers for the management of asthma include dry powder inhalers (DPIs) and pressurized metered-dose inhalers (pMDIs). The environmental impact of pMDIs, due to hydrofluorocarbon propellants, is a growing concern. OBJECTIVE: To conduct a carbon-utility analysis in mild asthma, comparing the clinical efficacy of DPIs versus pMDIs alongside their associated environmental impacts. METHODS: We performed a carbon-utility analysis using data from the Novel START trial, comparing 3 treatment strategies for mild asthma: as-needed budesonide/formoterol DPI, as needed salbutamol pMDI, and maintenance budesonide DPI plus as-needed salbutamol pMDI. We calculated carbon dioxide equivalent (kgCO2e) emissions per quality-adjusted life year (QALY) gained. Results were compared to predefined willingness-to-emit thresholds based on health care CO2e emissions in the United States, the European Union, and the United Kingdom. RESULTS: As-needed budesonide/formoterol DPI had a yearly carbon footprint of 1.1 kgCO2e and a utility of 0.936, compared with 26.2 kgCO2e and 0.935 for as-needed salbutamol pMDI, and 17.3 kgCO2e and 0.944 for maintenance budesonide DPI plus as-needed salbutamol pMDI. Compared with budesonide/formoterol, budesonide plus salbutamol resulted in 2192 more kgCO2e per QALY gained, exceeding the US per capita kgCO2e emissions in the health care sector and its 2030 target values. As-needed salbutamol was associated with higher CO2e emissions and lower utilities than budesonide/ formoterol. CONCLUSION: We applied to the asthma field a novel methodological approach to consider both the environmental impact and effectiveness of interventions. These findings indicate that as-needed budesonide/formoterol DPI is the preferred option when considering both carbon emissions and treatment effectiveness. (c) 2025 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2025;13:2649-56)I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
