New National Sustainable Asthma Care Roadmap to improve the lives of people with asthma and reduce the environmental impact of inhalers

The National Sustainable Asthma Care Roadmap was developed by Asthma Australia in partnership with Deakin University following a series of roundtables held in collaboration with 50 stakeholder organisations representing consumers, health care professionals, research, industry, peak bodies and government.

The Roadmap is in response to Australia's first National Health and Climate Strategy launched by the Australian Government in December 2023. The Strategy seeks to increase resilience to the health impacts of climate change and reduce greenhouse gas emissions from the Australian health system. It includes an action to improve respiratory health outcomes and reduce emissions from respiratory inhalers.

One in nine Australians live with asthma, and for around half of those people it is poorly controlled. The main causes of poor control are the overuse of 'reliever' medicines (predominantly salbutamol), and the underuse of 'preventer' medicines (predominantly inhaled corticosteroids).

Many asthma medicines come in pressurised metered-dose inhalers (pMDIs) that work by delivering a dose of medication propelled by a hydrofluorocarbon gas inhaled via a spacer. These propellants have a large carbon footprint. The same amount of medicine can be delivered effectively by a dry powder inhaler (DPI) with a reduced greenhouse impact. Additionally, there are some lower emissions propellant inhalers being developed and trialled internationally.

Around 25 million inhalers are sold in Australia each year and about 80% of these are pMDIs. Evidence from the UK suggests that changing to DPIs, when clinically appropriate, could reduce the environmental footprint of asthma care by 95%.

The recommendations from the Roadmap include a campaign to inform people with asthma about how to improve their asthma control – which has the potential to reduce emissions in itself – and how they can reduce greenhouse gas emissions from alternative inhalers where suitable devices are available. Further recommendations include reducing the cost and improving access to combination anti-inflammatory plus reliever inhalers, which are more effective than reliever inhalers alone (and are available in DPI), and increasing clinician knowledge and adoption of best practice in asthma care and sustainability.

Asthma Australia Director Health Knowledge and Translation Anthony Flynn said, 'The process of developing the Roadmap aimed to put people living with asthma at the centre of the conversation so that we are improving respiratory health as a primary goal while working towards environmentally friendly asthma care.

'This has been a sector-wide collaborative effort. We look forward to working with all those involved and the Australian and state and territory governments to progress the recommendations from the Roadmap and support the development of a national implementation plan.

'People with asthma interested in this information should discuss treatment options and the suitability of dry powder inhalers with their doctor.'

Dr Mike Forrester, Senior Research Fellow at Deakin's Institute for Health Transformation (IHT), said 'This a great example of health and planetary co-benefits. Our report details the underlying system challenges, the evidence regarding the evolution of guidelines, the footprint of care, and the eight collaboratively developed goals to support the Roadmap, with key recommendations and actions for the sector.

'Reducing the high rate of poorly controlled asthma and mitigating the environmental impact of pMDIs used to treat asthma represents a significant unmet need. Compelling evidence shows that transitioning to combination anti-inflammatory reliever asthma medication delivered using low-carbon devices can improve person-centred asthma outcomes while reducing greenhouse gas emissions.

'This Roadmap presents a compelling vision for the future of asthma care in Australia. We now hope to see investment and resources to translate these recommendations into a national implementation strategy.'

The full report is available here: Asthma-Roundtable-Report_DIGITAL_FINAL.pdf