[Translated article] Environmental impact of inhaled therapies in a cystic fibrosis unit: Strategies for sustainability

Abstract

Objective: Inhaled therapy is essential in cystic fibrosis; however, inhalers have a significant environmental impact due to the greenhouse gases (GHGs) emitted. The environmental impact of a product is estimated by its carbon footprint (CF). Pressurized metered-dose inhalers (pMDIs) have a higher CF than dry powder inhalers (DPIs) and soft mist inhalers (SMIs) due to the incorporation of GHGs. The objectives are to analyze the consumption of inhalers (β2-adrenergic agonist bronchodilators, anticholinergics, and/or corticosteroids) in a cystic fibrosis unit and estimate the generated CF. Method: Retrospective determination (January 2018-December 2023) of consumption and CF (tCO2eq) by type of inhaler was conducted. Consumption and CF trends were evaluated using linear regression. Results: Annually, 1.529 (1.279-1.613) pMDIs, 1.055 (855-1.333) DPIs, and 28 (20-42) SMIs were dispensed, representing 55.97%, 42.33%, and 1.70%, respectively. A statistically significant positive trend in the consumption of SMIs was observed. The median annual CF was: pMDIs 38.3 (31.2-40.3) tCO2eq, DPIs 0.8 (0.6-0.9) tCO2eq, and SMIs 0.02 (0.02-0.03) tCO2eq, representing 97.86%, 2.04%, and 0.10%, respectively. Conclusions: pMDIs were the inhalers with the highest consumption and CF, although their consumption appears to be decreasing, with an increase in the consumption of SMIs.

Objetivo La terapia inhalada es esencial en fibrosis quística; sin embargo, los inhaladores presentan un impacto medioambiental significativo derivado de los gases de efecto invernadero (GEI) emitidos. El impacto medioambiental de un producto se estima mediante su huella de carbono (HC). Los inhaladores de cartucho presurizado (pMDIs) presentan mayor HC que los inhaladores de polvo seco (DPIs) y de nube de vapor suave (SMIs) al incorporar GEI. Los objetivos son analizar el consumo de inhaladores (broncodilatadores agonistas β2-adrenérgicos, anticolinérgicos y/o corticoides) en una unidad de fibrosis quística y estimar la HC generada. Método Se determinó retrospectivamente (enero 2018-diciembre 2023) el consumo y la HC (tCO2eq) por tipo de inhalador. Se evaluó la tendencia de consumo y HC mediante regresión lineal. Resultados Se dispensaron anualmente 1.529 (1.279–1.613) pMDIs, 1.055 (855–1.333) DPIs y 28 (20–42) SMIs, representando el 55,97%; 42,33%; y 1,70%, respectivamente. Se observó una tendencia positiva estadísticamente significativa del consumo de SMIs. La HC mediana anual fue: pMDIs 38,3 (31,2–40,3) tCO2eq, DPIs 0,8 (0,6–0,9) tCO2eq y SMIs 0,02 (0,02–0,03) tCO2eq, representando, respectivamente, el 97,86%, 2,04% y 0,10%. Conclusiones Los pMDIs fueron los inhaladores con mayor consumo y HC, aunque parece que su consumo tiende a disminuir, incrementándose el de SMIs.