OBJECTIVES: International guidelines recommend triple therapy with long-acting antimuscarinic antagonists (LAMA), long-acting β-agonists (LABA), and inhaled corticosteroids only for patients with chronic obstructive pulmonary disease (COPD) who continue to exacerbate despite treatment with dual therapy. In clinical practice, triple therapy is often overprescribed. Further, inhaler device choice can also have a large impact on carbon footprint. This study aimed to assess the carbon footprint of hypothetically redistributing COPD patients, in line with international guidelines, on triple fixed dose combination (FDC) to LAMA/LABA soft-mist inhalers (SMI; Respimat® Spiolto).

METHODS: A model was established to assess the carbon footprint of redistributing triple therapy FDC to LAMA/LABA SMI (Respimat®) reusable in 12 European countries or disposable in the United States over 5 years. Inhaler use per country was derived from international prescribing data and CO₂ emissions from published sources. The proportion of patients overprescribed according to international guidelines was based on UK data (Vioix et al, 2020; Value Heal. Dec 1;23:S719) and applied to all European countries, or unpublished data from the United States.

RESULTS: In Europe, 50% of patients and 92% in the United States were assumed to be prescribed triple therapy FDC not in line with international recommendations (this difference in proportions is attributable to the data being based on different sources). Over 5 years, hypothetical redistribution of triple therapy FDC to SMI (Respimat®) reusable reduced CO₂ emissions by 70.7–98.4%. In the United States, redistribution to SMI (Respimat®) disposable reduced CO₂ emissions by 16.1%. Across all countries, CO₂ emissions were reduced by 143.7 kilo tonnes over 5 years, which is the equivalent of the annual carbon footprint of 21,447 EU citizens.

CONCLUSIONS: Prescribing SMI (Respimat®) dual therapy rather than triple therapy, where indicated, addresses both its inappropriate use, as well as reducing the carbon footprint.