Is respiratory care carbon conscious? Rationale and future implications for the CARBON respiratory programme

Aim: To overview the healthCARe-Based carbON cost of treatment (CARBON) sustainability program in respiratory care.Brief outline of context: Healthcare systems will need to achieve substantial reductions in greenhouse gas emissions as societies decarbonise their economies. Greater understanding of what comprises the ‘carbon footprint’ of care will identify effective strategies for its reduction. In respiratory medicine, the focus so far has been on preventer inhalers, thereby omitting contributions from healthcare resource utilisation (HCRU) and short-acting β2-agonist (SABA) relievers. SABA relievers contribute to the majority of inhaler usage and total carbon footprint of inhaler devices across many European countries. CARBON, a healthcare sustainability programme, seeks a broader understanding of the carbon footprint associated with respiratory care (Figure 1).Brief description of the change: In asthma, high SABA use is common and associated with poor disease control and increased risk of exacerbations.1 In chronic obstructive pulmonary disease (COPD), exacerbation history is linked with increased rate of future exacerbations.2 Both these cases drive an additional requirement for HCRU. CARBON is the first programme to quantify the carbon footprint of HCRU and medications in respiratory healthcare by using a combination of certified published studies and methodologies.Strategy for change: Understanding what comprises the carbon footprint of respiratory healthcare and how this is impacted by poor disease control or progression is the first step to understanding how innovative treatments and guideline implementation can drive carbon reduction. Patients with well-managed asthma and COPD are likely to have a lower carbon impact overall through reduced requirements for HCRU and SABA medication use.Message for others: Reducing carbon emissions is important and can be achieved without risking improvements in patient outcomes or causing harm. The principle of evidence-led care improvement as a means to achieve greater sustainability would have multiple benefits for patients and society as a whole. Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest The study was designed and funded by AstraZeneca. References and Clinical Trial Registry Information FitzGerald JM, et al. Respir Med. 2017;131:135−140.Haughney J, et al. Eur Respir J. 2020;56:4910.