Lauri Lehtimäki, Unnur Björnsdóttir, Christer Janson, Tari Haahtela
European Respiratory Journal 2020 55: 2000721; DOI: 10.1183/13993003.00721-2020
We read with interest the recent editorial by Keeley et al. on the timely topic of changing pressurised metered dose inhalers (pMDIs) to dry powder inhalers (DPIs) due to the much higher carbon footprint of pMDIs. We agree with the authors that global warming cannot be tackled only by focusing on inhaler devices, but as long as we can provide safe and effective treatment to our patients, we cannot overlook environmental facts either. We feel that Keeley et al. gave an unjustified negative impression on the performance of DPIs. They imply that DPIs are more expensive than pMDIs, that switching from pMDI to DPI leads to poorer asthma control, and that patients using DPIs should have a pMDI+spacer rescue pack since DPIs cannot be relied on as rescue medication. However, we feel that these misleading claims are based on wrong interpretations of the publications they cite, or on opinions without any supporting data. Since in many countries, like in Finland and Sweden, good control of asthma and COPD is achieved at a national level while the majority of patients using inhaled therapies are treated with DPIs, (56% in Finland and 71% in Sweden, according to IQVIA standard units volume data for 2019), we think it is worth correcting these wrong impressions.
Environmental burden of inhaled therapies needs to be considered, as long as treatment efficacy and safety are secured https://bit.ly/3bRSl07
Conflict of interest: L. Lehtimäki reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, GSK, Novartis, Mundipharma, Orion Pharma, Sanofi and Teva, outside the submitted work.
Conflict of interest: U. Björnsdóttir reports personal fees from AstraZeneca, Novartis and Sanofi, outside the submitted work.
Conflict of interest: C. Janson reports personal fees for educational activities from AstraZeneca, Chiesi, Boehringer Ingelheim, GlaxoSmithKline, Novartis and Teva, outside the submitted work.
Conflict of interest: T. Haahtela reports personal fees for lectures from GSK, Mundipharma and Orion Pharma, during the conduct of the study.