ArticleNPJ primary care respiratory medicine2025
Carbon emissions from the increasing use of inhaled corticosteroid-LABA medications: a primary care used case from Singapore.
Article in NPJ primary care respiratory medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Comparing 6-Year Carbon Footprint Between GINA Track 1 and 2 Asthma Management for Adults: A Real-World Primary Care Report from Singapore to Advocate for Policy Change in Inhaler Procurement.Journal of primary care & community healthArticle
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Authors and funding
5 authors.
Funding
Abstract
Patients are using more inhaled corticosteroids (ICS)-long-acting β2-agonist (LABA), with add-on short-acting β2-agonist (SABA) as reliever based on guidelines. The ICS-LABA inhalers are available in Singapore in either pressurized metered-dose (pMDI) or dry-power (DPI) inhalers. Both generate carbon emissions. This retrospective study aimed to determine the asthma control and quantify the carbon emissions resulting from the use of ICS-LABA inhalers by adults who were managed in primary care and comparing them between those with good versus suboptimal asthma control. Data of Asian patients aged >=21 years with a clinical diagnosis of asthma were extracted from their electronic medical records in nine Singapore primary care clinics from 2015-2023, including their demography, clinical diagnoses, asthma control test (ACT) scores and medications dispensed from in-house pharmacies. ACT ≥ 20 is regarded as good asthma control. The total carbon emissions from ICS-LABA and SABA (pMDI or DPI) were calculated respectively. Patients using ICS-LABA increased from 2021 (2015) to 6606 (2023); those with well-controlled asthma rose from 57.1-75.9%. Total carbon emissions increased from 106,871-367,832 kg CO2e/year and from 361,335 (2015) to 797,016 (2023) kg CO2e/year for ICS-LABA and ICS-LABA+SABA respectively. Each patient emitted average of 120.7 kg CO2e/year from ICS-LABA+SABA in 2023, a decline from 178.8 kg CO2e in 2015. Patients with suboptimal asthma control had significantly higher carbon emissions by 35 kg CO2e/year compared to those with good control (p < 0.001). More patients were treated with ICS-LABA from 2015-2023, but their total carbon emissions declined with better asthma control and reduced SABA usage.
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