Written by:
Robert Fogel
Vice President, Global Medical Affairs, Respiratory & Immunology, AstraZeneca
We are deeply committed to transforming respiratory care. As leaders in respiratory for more than five decades, we continue to drive innovation that benefits patients, society and the planet, affirmed by our presence at this year’s European Respiratory Society Congress.
As a founding partner of the International Respiratory Coalition (IRC) alongside the European Respiratory Society (ERS), patient groups and other industry partners, as well as our active participation in the Speak Up for COPD coalition, we seek to improve respiratory health through policy prioritisation, the introduction of national respiratory strategies and updating of guidelines and encouraging greater implementation of evidence-based guidelines to improve patient outcomes.
We are also passionately focused on continued scientific and medical innovation pursuing a full, integrated, portfolio so that healthcare professionals can offer patients more improved options to manage their condition, including therapies that treat the underlying drivers of their disease.
We know our work to improve outcomes is vital, not only to improve the lives of patients – ensuring they get the right treatment at the right time – but also to reduce the environmental burden of care. We believe that earlier intervention, proactive management and adopting global recommendations such as GOLD and GINA are key to preventing exacerbations, hospitalisations and ultimately death from respiratory diseases.1,2 Well-controlled respiratory disease has the potential to combine benefits for both patients and the environment by reducing the carbon footprint of care and improve the lives of millions around the world.3
Respiratory diseases are complex, difficult to treat, and significant unmet needs persist
Nearly 550 million people worldwide are affected by chronic respiratory diseases,4 including asthma and COPD, which are associated with high morbidity, mortality, delayed diagnosis / treatment leading to sub-optimal disease control, and its associated risks, as well as greater healthcare resource utilisation (HCRU).3,5-7 By 2030, one in six people will be over the age of 60.8 As the populations rapidly age, the prevalence of poorly controlled disease is also likely to increase in many countries,9 putting further strain and demand on healthcare systems.3 This has an obvious societal and economic impact and is predicted to lead to the worsening of respiratory diseases over the next 10 years. Unfortunately, few countries have national respiratory strategies to prioritise these issues, placing increased pressure on already stretched health systems.
Working towards remission as an achievable treatment goal in asthma
Helping patients achieve remission in asthma is central to our ambition.
All patients, regardless of disease severity, are at risk of asthma attacks particularly if they remain uncontrolled.10-12 Across the UK, Europe and USA, approximately half of those with asthma are poorly controlled10,13,14 with many patients waiting months to years to see an asthma specialist.15 This leaves them at risk of irreversible damage from inadequately managed asthma,16,17 as well as the widely acknowledged side effects of repeated or prolonged oral corticosteroid usage.2,18,19 This places additional pressure on stretched healthcare resources and costs.20
To combat this preventable situation, the Severe Asthma Policy Group developed a new call to action earlier this year, urging governmental institutions and policymakers to prioritise severe asthma care. Optimising care by driving earlier intervention and implementing evidence-based guidelines can reduce exacerbations, improve patient outcomes and may also decrease the overall carbon footprint through fewer hospitalisations, less medication use and fewer sick days.2,21-27
Addressing cardiopulmonary risk to reduce COPD mortality
COPD is a major public health threat28 and a leading cause of death globally.29 Despite this, it is often under-prioritised, underfunded and undertreated.5,30, 31
To reduce the unacceptably high mortality rates that have remained stagnant in COPD for over 20 years,29,30,32,33 there has been a recent groundswell of support to address the elevated risk that people who are diagnosed with COPD have of both lung and heart events – cardiopulmonary risk.34 This risk increases following an exacerbation, and this elevated risk may persist for up to a year.35-37 Sadly, approximately one in five patients die within a year of their first hospitalisation resulting from an exacerbation.38-39
This makes addressing cardiopulmonary risk – from the first COPD diagnosis or hospital visit – crucial. Early intervention, proactive care, implementation of guidelines and evidence-based medicine are key to preventing exacerbations and reducing the irreversible impact COPD can have.40-44 These strategies will lead to more patients with well controlled disease, improving outcomes and reducing demand on healthcare services.40,41
COPD Quality standards call for early and accurate diagnosis through education, follow-up care and access to treatment following hospital discharge from an exacerbation.45 Growing evidence suggests that COPD hospital discharge bundles, comprising evidence-based best practices, are important to improve patient outcomes, address high COPD readmission rates and ensure continuity of care following an exacerbation.46 As most COPD is managed in primary care, it also has a significant role in implementing these standards, as well as ensuring timely diagnosis and referral to specialists, when needed.47,48 Additionally, calls from across the respiratory community emphasize that COPD should be addressed and treated with a similar sense of urgency as other chronic illnesses (for example, following a heart attack or stroke).
This urgent need is why we are calling on policymakers to make health system policy revisions to improve the quality and consistency of COPD care worldwide, for every person with COPD, regardless of socioeconomic status or geographical location.
Decarbonising respiratory care
Estimates suggest the climate crisis is likely to cause 250,000 additional deaths per year globally between 2030 and 2050.49 Poor air quality and extreme weather conditions pose great risks to those already living with respiratory disease,49,50 all of which will increase demand on already stretched healthcare systems, which subsequently have a greater impact on the environment.49
To achieve sustainable healthcare, we are working in collaboration with the respiratory community to drive action towards net zero, resilient, and equitable health systems.
Every interaction a patient has with their health system carries a carbon footprint. As health systems aim to provide the best care for patients, they also generate greenhouse gases, contributing to the burden of respiratory diseases.3,6,51 For example, COPD is the leading cause of hospitalisations in many countries. Missed opportunities for optimal disease management leads to negative disease progression, greater HCRU and an increased carbon footprint.3,6
Our work to move towards earlier intervention to improve outcomes for patients and decarbonise the footprint of care is coupled with our commitment to reduce the carbon footprint of our medicines. To achieve this, we are accelerating the transition of our inhaled respiratory medicines to an innovative propellant with near-zero global warming potential – 99.9% lower than in today’s medicines. We anticipate first transition to these propellants from 2025 onwards, subject to regulatory approvals.52
We are also implementing a CO2 optimisation framework to allow clinical teams to critically reflect on their proposed study design and encourage them to consider the balance between aspects that are critical for study integrity and those providing important insights.
Powerful ways to help patients and the planet
We cannot reinforce enough the strong interconnection between healthy people and a healthy planet. Earlier intervention and disease control to prevent exacerbations and hospitalisations are some of the most powerful ways to improve outcomes for patients and reduce overall HCRU, and thus also the carbon footprint of care.6,21-25,43,45
We are working to deliver transformative change across the patient journey, disease continuum and driving for earlier intervention. But we are not stopping there; we have already delivered inhaled therapies and biologics to treat the broad spectrum of asthma. As respiratory care evolves, we are looking into the future, and exploring underlying biologic drivers and the potential of pre-biologics and new modalities, ensuring there are viable solutions at every stage of respiratory diseases.
Together with the respiratory community we will not stop until we see all patients receiving prompt earlier intervention to improve their lives, and reduce the impact on healthcare systems, society and the planet. Together we will transform respiratory care.
You may also like
References
1. GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024. [Online]. Available at: http://goldcopd.org/2024-gold-report/ [Last accessed: August 2024]
2. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2022. Available at: http://ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf. [Last accessed: August 2024]
3. Wilkinson A, et al. Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe‒Based envirONmental cost of treatment (CARBON) study. Thorax. 2024 Feb 27;79(5):412-421.
4. GBD Chronic Respiratory Disease Collaborators. Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Respir Med. 2020 Jun; 8 (6): 585-596.
5. Quaderi, S. A., & Hurst, J. R. The unmet global burden of COPD. Glob Health Epidemiol Genom. 2018 Apr 6:3:e4
6. Bell J, et al. EXACOS CARBON: Describing the Greenhouse Gas Emissions of Healthcare Resource Utilization by Frequency and Severity of COPD Exacerbation in England. Poster Presentation at American Thoracic Society (ATS) international congress, 2024. 17-22 May.
7. ARUP. Health care’s climate footprint. [Online]. Available at: http://www.arup.com/perspectives/publications/research/section/healthcares-climate-footprint [Last accessed: August 2024]
8. World Health Organization. Factsheet: Ageing and health. Available at: http://www.who.int/news-room/fact-sheets/detail/ageing-and-health. [Last accessed: August 2024]
9. CDC. Chronic Diseases and Cognitive Decline — A Public Health Issue. Available at: http://www.cdc.gov/aging/publications/chronic-diseases-brief.html. [Last Accessed August 2024]
10. Price D, et al. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014; 24: 14009.
11. Bloom CI, et al. Exacerbation risk and characterisation of the UK's asthma population from infants to old age. Thorax. 2018; 73: 313-320.
12. Papi A, et al. Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma. J Allergy Clin Immunol Pract. 2018; 6: 1989-1998.
13. CDC. Uncontrolled Asthma Among Children With Current Asthma, 2018–2020. [Online]/Available at: http://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-children-2018-2020.htm [Last accessed: August 2024]
14. Fletcher M, Hiles D. Continuing discrepancy between patient perception of asthma control and real-world symptoms: a quantitative online survey of 1,083 adults with asthma from the UK. Prim Care Respir J. 2013 Dec;22(4):431-8.
15. Rupani H, et al. 2022. P145 What is the severe asthma patient journey to biologic initiation in UK severe asthma centres? Thorax. 77(Suppl 1): A159-A60.
16. Nwaru BI, et al. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020; 55 (4): 1901872.
17. Lloyd A, et al. The impact of asthma exacerbations on health-related quality of life in moderate to severe asthma patients in the UK. Prim Care Respir J. 2007; 16 (1): 22-7.
18. Price DB, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018; 11: 193–204.
19. EPR-3: Expert panel report 3. Guidelines for the Diagnosis and Management of Asthma 2007 (EPR-3). [Online]. Available at: http://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma. [Last accessed: August 2024]
20. The Global Asthma Network. The Global Asthma Report 2022. [Online]. Available at: http://globalasthmareport.org/index.html [Last accessed: August 2024]
21. SMI. Decarbonising patient care pathways. [Online]. Available at: http://a.storyblok.com/f/109506/x/88fe7ea368/smi-hstf-pcp-whitepaper.pdf. [Accessed August 2024].
22. Levy ML, et al. Global access and patient safety in the transition to environmentally friendly respiratory inhalers: the Global Initiative for Asthma perspective. Lancet. 2023;S0140-6736(23)01358-2.
23. Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag. 2019;15:461-472.
24. Usmani O, Levy ML. Effective respiratory management of asthma and COPD and the environmental impacts of inhalers. NPJ Prim Care Respir Med. 2023;33(1):24.
25. Bjermer L. The importance of continuity in inhaler device choice for asthma and chronic obstructive pulmonary disease. Respir. 2014;88(4):346-352.
26. Usmani O, et al. Consensus quality standard for implementing inhaler regimen switch in patients with respiratory disease. European Respiratory Society Congress 2023. Poster #PA4607.
27. Doyle S, et al. What happens to patients who have their asthma device switched without their consent? Prim Care Respir J. 2010; 19 (2): 131–139.
28. Adeloye D, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;Vol 10(5); 447-458
29. World Health Organization. Global Health Estimates 2019: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. Global Summary Estimates. Geneva 2020. Available at http://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death [Last accessed: August 2024].
30. Make B, et al. Undertreatment of COPD: a retrospective analysis of US managed care and Medicare patients. Int J Chron Obstruct Pulmon Dis . 2012; 7: 1.
31. Ballreich JM, et al. Allocation of National Institutes of Health Funding by Disease Category in 2008 and 2019. JAMA Netw Open. 2021; 4(1): e2034890.
32. Centres for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease (COPD): National Trends. 2022. Available at: http://www.cdc.gov/copd/data-and-statistics/national-trends.html. [Last accessed: August 2024].
33. Marshall D, et al. Trends in prevalence, mortality, and disability-adjusted life-years relating to chronic obstructive pulmonary disease in Europe: an observational study of the global burden of disease database, 2001-2019. BMC Pulm Med. 2022; 22:289.
34. Swart K, et al. Risk of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: results from the EXACOS-CV cohort study using the PHARMO Data Network in the Netherlands. Respiratory Research.(2023) Vol 24: 293
35. Kunisaki KM, et al. Exacerbations of Chronic Obstructive Pulmonary Disease and Cardiac Events. A Post Hoc Cohort Analysis from the SUMMIT Randomized Clinical Trial. AM J Respir Crit Care Med. 2018;198(1):pp.51-57
36. Halpin DMG, et al. Effect of a single exacerbation on decline in lung function in COPD. Respir Med. 2017; 128: 85-91.
37. Vogelmeier C, et al. Increased risk of severe cardiovascular events following exacerbations of COPD: a multi-database cohort study. [Poster] Presented at the European Respiratory Society International Congress 2023.
38. Lindenauer PK, et al. Risk Trajectories of Readmission and Death in the First Year After Hospitalization for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018;197(8):1009-1017.
39. Ho TW, et al. In-Hospital and One-Year Mortality and Their Predictors in Patients Hospitalized for First-Ever Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Population-Based Study. PLOS ONE. 2014; 9 (12): e114866
40. Patel J, et al. Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States. Int J Chron Obstruct Pulmon Dis. 2014; 19:9:289-300.
41. Jansen EM, et al. Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers. J Thorac Dis. 2021 Jun;13(6):3846-3864.
42. Scarffe, AD, et al. Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting. Cost Eff Resour Alloc. 2022;12;20(1):39.
43. Rabe KF, et al. Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very Severe COPD. N Engl J Med; 2020; 383: pp.35-48.
44. Pollack M, et al. Exacerbations and real-world outcomes (EROS) among patients with COPD receiving single inhaler triple therapy of budesonide/glycopyrrolate/formoterol fumarate [Poster Discussion]. Presented at the American Thoracic Society International Conference 2023 (19-24 May)
45. Bhutani M, et al. Quality Standard Position Statements for Health System Policy Changes in Diagnosis and Management of COPD: A Global Perspective. Adv Ther. 2022 Jun;39(6):2302-2322.
46. Miravitlles M, et al. Implementing an Evidence-Based COPD Hospital Discharge Protocol: A Narrative Review and Expert Recommendations. Adv Ther. 2023; 40,4236–4263 (2023).
47. Wilkinson TM, et al. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir; 2004;169:1298-303
48. Stolz D, et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet. 2022; 400 (10356);921-972.
49. World Health Organization. Factsheet: Climate change. Available at: http://www.who.int/news-room/fact-sheets/detail/climate-change-and-health. [Last accessed August 2024]
50. World Health Organization. Ambient (outdoor) air pollution. [Online]. Available at: http://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health. [Last accessed August 2024]
51. Tennison I, et al. "Health care's response to climate change: a carbon footprint assessment of the NHS in England." Lancet Planetary Health. 2021; 5.2: e84-e92.
52. AstraZeneca news release. AstraZeneca progresses Ambition Zero Carbon programme with Honeywell partnership to develop next-generation respiratory inhalers. [Online]. Available at: http://type.a220149.com/content/astraz/media-centre/press-releases/2022/astrazeneca-progresses-ambition-zero-carbon-programme-with-honeywell-partnership-to-develop-next-generation-respiratory-inhalers.html. [Last accessed August 2024]
Veeva ID: Z4-67481
Date of preparation: August 2024