Greenhouse Gas Emissions Associated With Severe Asthma Care in the United Kingdom

IF 6.6 1区医学 Q1 ALLERGY Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-07-01 Epub Date: 2025-02-21 DOI:10.1016/j.jaip.2025.02.012

Alex Wilkinson BM BCh, MRCP , Mina Khezrian PharmD, PhD , Liam G. Heaney MD , Soram Patel BMBS , Jennifer K. Quint PhD, MD, MSc, BSc, FRCP , Hitasha Rupani MRCP, PhD , Eleni Rapsomaniki PhD , Kirsty Rhodes PhD , Andrew N. Menzies-Gow PhD, FRCP , Trung N. Tran MD, PhD

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Abstract

Background

The 2023 United Nations Climate Change Conference (COP28) Declaration on Climate and Health promotes steps to curb emissions and reduce waste in the health sector.

Objective

To describe and quantify greenhouse gas (GHG) emissions associated with severe asthma (SA) care in the United Kingdom, by carbon source and transition status from SA to severe uncontrolled asthma (SUA) and/or regular specialist care (RSC).

Methods

This was a cohort study using routinely collected data from the Clinical Practice Research Datalink Aurum, Hospital Episode Statistics, and CO₂ equivalent emissions data. Patients were ≥12 years old at the index date (ie, date of first recorded inhaled corticosteroid [ICS] + controller prescription) with a validated asthma diagnosis. Total GHG emissions and GHG emissions related to medications, exacerbations, and health care resource utilization (HCRU) were estimated, overall and by transition along stages of the SA-SUA-RSC continuum. Five pathways and stage orders were identified: (1) SA, (2) SA-SUA, (3) SA-RSC, (4) SA-RSC-SUA, and (5) SA-SUA-RSC.

Results

The total CO₂ equivalent for the SA population (n = 93,054) was 2167 tonnes/10,000 patients/year. GHG emissions were 5.2% to 23.0% greater for patients transitioned to SUA (vs previous stage), mostly due to exacerbation-related emissions (4.2-7.7 times greater; predominantly hospitalizations) and medication-related emissions (3.5%-10.9% greater; predominantly short-acting β₂-agonists [SABAs]). Conversely, total GHG emissions decreased by 12.1% to 23.9% for those referred to RSC, due to decreased exacerbation-related emissions (1.7-5.2 times lower; all sources) and medication-related emissions (14.8%-20.6% lower; both SABA and overall ICS).

Conclusion

Our findings suggest that RSC not only improves patient outcomes but also reduces GHG emissions in line with aims to reduce the health sector’s contribution to the total national carbon footprint.

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在英国，温室气体排放与严重哮喘护理有关。

背景：《第二十八届缔约方会议气候与健康宣言》促进采取措施，在卫生部门遏制排放和减少浪费。目的：描述和量化英国严重哮喘（SA）护理相关的温室气体（GHG）排放，包括碳源和从SA到严重未控制哮喘（SUA）和/或常规专科护理（RSC）的过渡状态。方法：这是一项队列研究，使用临床实践研究数据链Aurum、医院事件统计和二氧化碳当量排放数据的常规收集数据。患者在索引日期（即首次记录ICS +控制器处方的日期）≥12岁，并经证实的哮喘诊断。总体上和沿着SA-SUA-RSC连续体的过渡阶段估计了与总、药物、恶化和医疗保健资源利用（HCRU）相关的温室气体排放。确定了5种通路和阶段顺序：1。SA) 2。SA-SUA 3。SA-RSC 4。SA-RSC-SUA 5。SA-SUA-RSC。结果：SA人群（n=93,054）的总二氧化碳当量为2167吨/10K患者/年。与前一阶段相比，过渡到SUA的患者的温室气体排放量增加了5.2-23.0%，主要是由于加重相关的排放(4.2-7.7倍；主要是住院)和与药物有关的排放(增加3.5-10.9%；主要是普利)。相反，由于与恶化相关的排放减少（降低1.7-5.2倍），RSC的温室气体总排放量减少了12.1-23.9%；所有来源)和与药物有关的排放(降低14.8-20.6%；SABA和整体ICS)。结论：我们的研究结果表明，RSC不仅改善了患者的预后，而且减少了温室气体排放，符合减少卫生部门对国家总碳足迹的贡献的目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.