按需布地奈德-福莫特罗治疗轻度哮喘的碳足迹:事后分析
2024/04/24
摘要
引言：压力计量吸入器（pMDI）的使用以及引发哮喘急性发作需要进行医疗评估，这两者对全球医疗碳足迹的贡献相当大。根据全球哮喘倡议(GINA)的建议，将轻度哮喘患者从沙丁胺醇pMDI缓解治疗转为吸入皮质类固醇-福莫特罗干粉吸入器(DPI)缓解治疗，可能有助于减少碳足迹。
方法：这个后续分析包括了 Novel START 试验中的所有 668 名成年参与者，他们被随机分配到以下三种治疗中的一种：按需使用布地奈德-福莫特罗 DPI、按需使用沙丁胺醇 pMDI，或者维持治疗使用布地奈德 DPI 并按需使用沙丁胺醇 pMDI。主要结果是哮喘管理的碳足迹，以碳排放量的千克二氧化碳当量（kgCO2e）表示，每人每年一次。次要结果探讨了基线症状控制和依从性（仅在维持治疗时使用布地奈德 DPI 组）对碳足迹的影响。
结果：按需使用布地奈德-福莫特罗 DPI 与按需使用沙丁胺醇 pMDI（最小二乘均值 1.1 对比 26.2 kgCO2e；差异 -25.0，95% CI -29.7 至 -20.4；p<0.001）和维持治疗使用布地奈德 DPI 加按需使用沙丁胺醇 pMDI（最小二乘均值 1.1 对比 17.3 kgCO2e；差异 -16.2，95% CI -20.9 至 -11.6；p<0.001）相比，碳足迹分别降低了 95.8% 和 93.6%。在维持治疗使用布地奈德 DPI 组中，治疗间碳足迹的差异是否取决于基线症状控制或依从性没有统计学显著的证据。
结论：按需使用布地奈德-福莫特罗 DPI 治疗选择与按需使用沙丁胺醇 pMDI 和维持治疗使用布地奈德 DPI 加按需使用沙丁胺醇 pMDI 相比，碳足迹明显更低。
The carbon footprint of as-needed budesonide-formoterol in mild asthma: a post hoc analysis
Lee Hatter, Mark Holliday, Allie Eathorne, Pepa Bruce, Ian D Pavord, Helen K Reddel, Robert J Hancox, Alberto Papi, Mark Weatherall, Richard Beasley
Abstract
Introduction: The use of pressurised metered-dose inhalers (pMDIs) and asthma exacerbations necessitating healthcare reviews contribute substantially to the global carbon footprint of healthcare. It is possible that a reduction in carbon footprint could be achieved by switching patients with mild asthma from salbutamol pMDI reliever therapy to inhaled corticosteroid-formoterol dry powder inhaler (DPI) reliever therapy, as recommended by the Global Initiative for Asthma (GINA).
Methods: This post hoc analysis included all 668 adult participants in the Novel START trial, who were randomised 1:1:1 to treatment with: as-needed budesonide-formoterol DPI, as-needed salbutamol pMDI, or maintenance budesonide DPI plus as-needed salbutamol pMDI. The primary outcome was carbon footprint of asthma management, expressed as kilograms of carbon dioxide equivalent emissions (kgCO2e), per person year. Secondary outcomes explored the effect of baseline symptom control and adherence (maintenance budesonide DPI arm only) on carbon footprint.
Results: As-needed budesonide-formoterol DPI was associated with 95.8% and 93.6% lower carbon footprint compared with as-needed salbutamol pMDI (least squares mean 1.1 versus 26.2 kgCO2e; difference -25.0, 95% CI -29.7 to -20.4; p<0.001) and maintenance budesonide DPI plus as-needed salbutamol pMDI (least squares mean 1.1 versus 17.3 kgCO2e; difference -16.2, 95% CI -20.9 to -11.6; p<0.001), respectively. There was no statistically significant evidence that treatment differences in carbon footprint depended on baseline symptom control or adherence in the maintenance budesonide DPI arm.
Conclusions: The as-needed budesonide-formoterol DPI treatment option was associated with a markedly lower carbon footprint than as-needed salbutamol pMDI and maintenance budesonide DPI plus as-needed salbutamol pMDI.
引言：压力计量吸入器（pMDI）的使用以及引发哮喘急性发作需要进行医疗评估，这两者对全球医疗碳足迹的贡献相当大。根据全球哮喘倡议(GINA)的建议，将轻度哮喘患者从沙丁胺醇pMDI缓解治疗转为吸入皮质类固醇-福莫特罗干粉吸入器(DPI)缓解治疗，可能有助于减少碳足迹。
方法：这个后续分析包括了 Novel START 试验中的所有 668 名成年参与者，他们被随机分配到以下三种治疗中的一种：按需使用布地奈德-福莫特罗 DPI、按需使用沙丁胺醇 pMDI，或者维持治疗使用布地奈德 DPI 并按需使用沙丁胺醇 pMDI。主要结果是哮喘管理的碳足迹，以碳排放量的千克二氧化碳当量（kgCO2e）表示，每人每年一次。次要结果探讨了基线症状控制和依从性（仅在维持治疗时使用布地奈德 DPI 组）对碳足迹的影响。
结果：按需使用布地奈德-福莫特罗 DPI 与按需使用沙丁胺醇 pMDI（最小二乘均值 1.1 对比 26.2 kgCO2e；差异 -25.0，95% CI -29.7 至 -20.4；p<0.001）和维持治疗使用布地奈德 DPI 加按需使用沙丁胺醇 pMDI（最小二乘均值 1.1 对比 17.3 kgCO2e；差异 -16.2，95% CI -20.9 至 -11.6；p<0.001）相比，碳足迹分别降低了 95.8% 和 93.6%。在维持治疗使用布地奈德 DPI 组中，治疗间碳足迹的差异是否取决于基线症状控制或依从性没有统计学显著的证据。
结论：按需使用布地奈德-福莫特罗 DPI 治疗选择与按需使用沙丁胺醇 pMDI 和维持治疗使用布地奈德 DPI 加按需使用沙丁胺醇 pMDI 相比，碳足迹明显更低。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Eur Respir J. 2024 Apr 12:2301705. doi: 10.1183/13993003.01705-2023.)
(Eur Respir J. 2024 Apr 12:2301705. doi: 10.1183/13993003.01705-2023.)
The carbon footprint of as-needed budesonide-formoterol in mild asthma: a post hoc analysis
Lee Hatter, Mark Holliday, Allie Eathorne, Pepa Bruce, Ian D Pavord, Helen K Reddel, Robert J Hancox, Alberto Papi, Mark Weatherall, Richard Beasley
Abstract
Introduction: The use of pressurised metered-dose inhalers (pMDIs) and asthma exacerbations necessitating healthcare reviews contribute substantially to the global carbon footprint of healthcare. It is possible that a reduction in carbon footprint could be achieved by switching patients with mild asthma from salbutamol pMDI reliever therapy to inhaled corticosteroid-formoterol dry powder inhaler (DPI) reliever therapy, as recommended by the Global Initiative for Asthma (GINA).
Methods: This post hoc analysis included all 668 adult participants in the Novel START trial, who were randomised 1:1:1 to treatment with: as-needed budesonide-formoterol DPI, as-needed salbutamol pMDI, or maintenance budesonide DPI plus as-needed salbutamol pMDI. The primary outcome was carbon footprint of asthma management, expressed as kilograms of carbon dioxide equivalent emissions (kgCO2e), per person year. Secondary outcomes explored the effect of baseline symptom control and adherence (maintenance budesonide DPI arm only) on carbon footprint.
Results: As-needed budesonide-formoterol DPI was associated with 95.8% and 93.6% lower carbon footprint compared with as-needed salbutamol pMDI (least squares mean 1.1 versus 26.2 kgCO2e; difference -25.0, 95% CI -29.7 to -20.4; p<0.001) and maintenance budesonide DPI plus as-needed salbutamol pMDI (least squares mean 1.1 versus 17.3 kgCO2e; difference -16.2, 95% CI -20.9 to -11.6; p<0.001), respectively. There was no statistically significant evidence that treatment differences in carbon footprint depended on baseline symptom control or adherence in the maintenance budesonide DPI arm.
Conclusions: The as-needed budesonide-formoterol DPI treatment option was associated with a markedly lower carbon footprint than as-needed salbutamol pMDI and maintenance budesonide DPI plus as-needed salbutamol pMDI.
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基于前瞻性出生队列的多种族儿童早期代谢组学特征及食物过敏和哮喘风险研究
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度普利尤单抗治疗哮喘儿童的长期安全性及有效性评估（自由哮喘研究）：一项开放标签扩展研究
