Carbon footprint of inhalers in respiratory treatment: SABA CARBON International

A Alzaabi, J Bell, F Montero-Arias, D Price, D Jackson, H Wang, N Budgen, H Farouk, E Maslova

Research output: Contribution to journalAbstractpeer-review


Background: The environmental impact of preventer inhalers has been a recent focus in respiratory care, despite widespread SABA overuse (≥3 canisters/year) and associated poor outcomes.Aim: To assess greenhouse gas (GHG) emissions for SABA vs total inhaler use (all respiratory indications), and SABA overuse for asthma, in Africa, Asia-Pacific, Latin America, and the Middle East as part of the CARBON programme.Methods: This observational study used IQVIA™ sales data (2018–2019) for inhalers (all respiratory conditions) and SABINA III SABA prescription/ OTC purchase data for asthma (2019–2020) (Bateman ED, et al. ERJ 2021:2101402). GHG emissions as CO2 equivalents (CO2e) per actuation or canister were used for calculations.Results: SABAs accounted for ≥50% of inhaler sales in 22/28 countries and inhaler-related GHG emissions in 24/28 countries (>70% in 19/28 countries). Across geographic regions and economies, >85% of SABA was prescribed to overusers. Per capita GHG emissions linked to SABA overuse were 866 and 732 tonnes CO2e/10,000 persons/year, with and without SABA OTC, respectively.Conclusion: SABA comprises most of the inhaler use and inhaler-related GHG emissions, with overuse in asthma representing a potentially modifiable environmental impact. Implementing current treatment recommendations could improve disease control, reducing SABA overuse and HCRU and benefiting both patients and the environment.FootnotesCite this article as Eur Respir J 2022; 60: Suppl. 66, 2901.This article was presented at the 2022 ERS International Congress, in session “-”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at (ERS member access only).
Original languageEnglish
Article number2901
JournalEuropean Respiratory Journal
Issue numberSuppl. 66
Publication statusPublished - 4 Sep 2022
EventEuropean Respiratory Society (ERS) International Congress. - FIRA Barcelona Gran Via Congress Centre, Barcelona, Spain
Duration: 4 Sep 20226 Sep 2022


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