Carbon footprint of inhalers in respiratory treatment: SABA CARBON International

Ashraf Al Zaab, John Bell, Felicia Montero-Arias, David Price, David J Jackson, Hao-Chien Wang, Nigel Budgen, Hisham Farouk, Ekaterina 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.
Original languageEnglish
Article number2901
Number of pages3
JournalEuropean Respiratory Journal
Issue numberSuppl. 66
Early online date1 Nov 2022
Publication statusPublished - 1 Dec 2022
EventEuropean Respiratory Society (ERS) International Congress. - FIRA Barcelona Gran Via Congress Centre, Barcelona, Spain
Duration: 4 Sept 20226 Sept 2022

Bibliographical note

Funding statement: The study was designed and funded by AstraZeneca


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