OBJECTIVES: Policy interventions to reduce climate impacts are being increasingly considered by healthcare decision-makers in many countries, such as the National Health Service in England and Ministero della transizione ecologica in Italy. Dry powder inhalers (DPIs) for the treatment of asthma demonstrated significantly lower greenhouse gas emissions than pressurised metered-dose inhalers. An analysis was conducted to estimate the reduction in carbon dioxide equivalent (CO₂e) emissions related to once-daily indacaterol acetate/mometasone furoate (IND/MF) and once-daily indacaterol acetate/mometasone furoate/glycopyrronium bromide (IND/GLY/MF), delivered using Breezhaler^® DPI device, compared to existing inhalers in the UK and Italy.

METHODS: The environmental consequences of introducing IND/GLY/MF [150/50/160 µg] and IND/MF [125/62.5 µg, 125/127.5 µg, 125/260 µg]) in the Breezhaler^® device for the treatment of moderate-to-severe uncontrolled asthma were estimated over a period of 5 years. CO₂e emission values for the Breezhaler^® device + IND/MF or IND/GLY/MF and comparators were obtained from a life-cycle assessment study and published literature, respectively. Other key inputs included market share, prevalence and drug dose. The amount of saving in CO₂e emissions is equated with real-life activities needed to offset the same carbon footprint.

RESULTS: Assuming a 10% market share over the next 5 years, IND/GLY/MF Breezhaler^® would result in the respective reduction of approximately 4.9 and 0.8 million Kg of CO₂e emissions in the UK and Italy, which are equivalent to approximately 2M litres or 300K litres of gasoline consumption. The reduction in carbon emissions is also equivalent to planting approximately 40K and 6.6K new trees in the UK and Italy, respectively. Environmental benefits were also observed with IND/MF Breezhaler^®.

CONCLUSIONS: Increasing the use of Breezhaler^® DPI device results in environmental benefits in both UK and Italy. These data may help inform policy discussions and encourage decision-makers to consider the environmental impact of asthma inhalers alongside the standard reimbursement process.