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

• Published in: Thorax Vol. 79; no. 5; pp. 412 - 421
• Main Authors: Wilkinson, Alexander J K, Maslova, Ekaterina, Janson, Christer, Radhakrishnan, Vasanth, Quint, Jennifer K, Budgen, Nigel, Tran, Trung N, Xu, Yang, Menzies-Gow, Andrew, Bell, John P
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Thoracic Society 01.05.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Air pollution; Airway management; Asthma; Carbon; Carbon footprint; Chronic obstructive pulmonary disease; Climate change; Clinical medicine; Clinical practice guidelines; Disease control; Drug dosages; Drug therapy; Effectiveness; Emergency medical care; Emissions; Energy consumption; Environmental health; Environmental impact; Greenhouse gases; Health care industry; Health services utilization; Hospitalization; inhaler devices; Inhalers; Morbidity; Mortality; Patients; Primary care; Product life cycle; Steroids; United Kingdom > UK; Switzerland; asthma; inhaler devices
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2023-220259

BackgroundPoorly 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.MethodsPatients 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.ResultsOf 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.ConclusionsThese 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.