Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe-Based envirONmental cost of treatment (CARBON) study

Alexander J K Wilkinson; Ekaterina Maslova; Christer Janson; Vasanth Radhakrishnan; Jennifer K Quint; Nigel Budgen; Trung N Tran; Yang Xu; Andrew Menzies-Gow; John P Bell

doi:10.1136/thorax-2023-220259

Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe-Based envirONmental cost of treatment (CARBON) study

Thorax. 2024 Feb 27;79(5):412-421. doi: 10.1136/thorax-2023-220259. Online ahead of print.

Authors

Affiliations

¹ Department of Respiratory Medicine, East and North Hertfordshire NHS Trust, Stevenage, UK.
² BioPharmaceuticals Medical, AstraZeneca UK Ltd, Cambridge, UK.
³ Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
⁴ ZS Associates, Bengaluru, India.
⁵ National Heart Lung Institute, Imperial College London, London, UK.
⁶ Global Sustainability, AstraZeneca, Macclesfield, UK.
⁷ BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA.
⁸ BioPharmaceuticals Medical, AstraZeneca Switzerland, Baar, Switzerland john.bell2@astrazeneca.com.

Abstract

Background: Poorly controlled asthma is associated with increased morbidity and healthcare resource utilisation (HCRU). Therefore, to quantify the environmental impact of asthma care, this retrospective, cohort, healthCARe-Based envirONmental cost of treatment (CARBON) study estimated greenhouse gas (GHG) emissions in the UK associated with the management of well-controlled versus poorly controlled asthma.

Methods: Patients with current asthma (aged ≥12 years) registered with the Clinical Practice Research Datalink (2008‒2019) were included. GHG emissions, measured as carbon dioxide equivalent (CO₂e), were estimated for asthma-related medication use, HCRU and exacerbations during follow-up of patients with asthma classified at baseline as well-controlled (<3 short-acting β₂-agonist (SABA) canisters/year and no exacerbations) or poorly controlled (≥3 SABA canisters/year or ≥1 exacerbation). Excess GHG emissions due to suboptimal asthma control included ≥3 SABA canister prescriptions/year, exacerbations and any general practitioner and outpatient visits within 10 days of hospitalisation or an emergency department visit.

Results: Of the 236 506 patients analysed, 47.3% had poorly controlled asthma at baseline. Scaled to the national level, the overall carbon footprint of asthma care in the UK was 750 540 tonnes CO₂e/year, with poorly controlled asthma contributing excess GHG emissions of 303 874 tonnes CO₂e/year, which is equivalent to emissions from >124 000 houses in the UK. Poorly controlled versus well-controlled asthma generated 3.1-fold higher overall and 8.1-fold higher excess per capita carbon footprint, largely SABA-induced, with smaller contributions from HCRU.

Conclusions: These findings suggest that addressing the high burden of poorly controlled asthma, including curbing high SABA use and its associated risk of exacerbations, may significantly alleviate asthma care-related carbon emissions.

Keywords: asthma; inhaler devices.