Climate change and respiratory health: implications for respiratory clinicians in primary and specialist care.

The impact of climate change on chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease is becoming ever more apparent, with extremes of heat and cold, increased humidity, and severe weather events worsening the risk of negative outcomes in these patients, including mortality. In turn, climate change is altering the patterns and types of aeroallergens and viruses that also impact the day-to-day lives of patients with respiratory diseases. As a consequence, physicians caring for patients with chronic respiratory diseases may be especially interested in how climate change impacts these conditions and, conversely, how management of these diseases may affect the environment. In this setting, it is of note that poorly controlled respiratory diseases have a higher carbon footprint than well-controlled diseases, especially if an individual is hospitalised. Effective therapy that reduces the occurrence of symptoms and prevents exacerbations will therefore minimise the impact of a respiratory disease on the environment, regardless of the type of device used for delivery of maintenance therapy. In addition, any inhaler choice should be personalised, considering a patient's preference for, and ability to use the inhaler device correctly, but it is also important to consider the overall lifecycle carbon footprint of an inhaler, not only of the gases emitted. This narrative review summarises evidence on how climate change is impacting individuals with chronic respiratory diseases, and discusses how respiratory clinical practice can impact climate change. Importantly, we propose that the main contribution to minimising the impact of chronic respiratory diseases on the climate is to optimise disease control and self-management.