Respiratory Effectiveness Group Position Statement: Inhaler Choice: Balancing Personalized Health Care and Environmental Responsibility PDF Free Download

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Respiratory Effectiveness Group Position Statement: Inhaler Choice: Balancing Personalized Health Care and Environmental Responsibility PDF Free Download

Respiratory Effectiveness Group Position Statement: Inhaler Choice: Balancing Personalized Health Care and Environmental Responsibility PDF free Download. Think more deeply and widely.

Respiratory Effectiveness Group Position Statement:

Inhaler Choice: Balancing Personalized Health Care

and Environmental Responsibility

Omar S. Usmani,

Mona Al-Ahmad,

Keith Allan,

Antonio Anzueto,

Fulvio Braido,

Giorgio W. Canonica,

6,7

Trevor Lambert,

Thérèse Lapperre,

9,10

Alan Kaplan,

Marc Miravitlles,

Nikolaos G. Papadopoulos,

13,14

Chin Kook Rhee,

Nicolas Roche,

16,17

and Joan B. Soriano

18–21

;

On behalf of The Respiratory Effectiveness Group

To the Editor:

Inhaled medications are essential in managing asthma

and chronic obstructive pulmonary disease (COPD).

Delivery systems include dry powder inhalers (DPIs), pres-

surized metered-dose inhalers (pMDIs), soft mist inhalers,

and nebulizers. Historically, pMDIs used chloroﬂuorocarbon

(CFC) propellants, contributing to ozone depletion. While phar-

maceutical companies have transitioned to CFC-free pMDIs,

there are now international efforts to phase down propellants

with high global warming potential (GWP), with some govern-

ments and societies recommending switching from pMDIs due

to their GWP.

Our Position

The Respiratory Effectiveness Group (REG) is a not-for-

proﬁt initiative established by international experts in real-life

research in respiratory medicine. While we support environ-

mental responsibility, inhaler choice should be personalized,

balancing patient needs and environmental concerns. We

strongly oppose switching an inhaler for nonmedical reasons

without considering possible clinical consequences of a mis-

match between the inhaler’s characteristics and the patient’s

abilities and preferences.

A global study by REG,

surveyed 468 health care professio-

nals (HCPs) and 270 asthma/COPD patients across 39 countries

National Heart and Lung Institute, Imperial College London, London, United Kingdom.

Department of Microbiology, College of Medicine, Kuwait University, Kuwait City, Kuwait.

University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.

Medicine/Pulmonary Critical Care, South Texas Veterans Healthcare System, University of Texas Health, San Antonio, Texas, USA.

Department of Internal Medicine (DiMI), Respiratory Unit for Continuity of Care, University of Genoa, Genoa, Italy.

Department of Biomedical Sciences, Humanitas University, Milan, Italy.

Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.

Nufﬁeld Department of Population Health, University of Oxford, Oxford, United Kingdom.

Translational Research in Immunology and Inﬂammation, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp,

Antwerp, Belgium.

Department of Pneumology, Antwerp University Hospital, Edegem, Belgium.

Department of Family and Community Medicine, University of Toronto, Toronto, Canada.

Pneumology Department, Health Care Provider of the European Reference Network On Rare Respiratory Diseases (ERN LUNG), Hospital

Universitari Vall d’Hebron/Vall d’Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain.

Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.

Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester,

United Kingdom.

Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea.

Inserm U1016, Institut Cochin, Université Paris Cité, Paris, France.

Respiratory Medicine, Cochin Hospital; Assistance Publique Hôpitaux de Paris Centre, Paris, France.

Facultat de Medicina, Universitat de les Illes Balears, Palma de Mallorca, Spain.

Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain.

Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.

ªThe Author(s) 2025. Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative

Commons License [CC-BY] (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in

any medium, provided the original work is properly cited.

JOURNAL OF AEROSOL MEDICINE AND PULMONARY DRUG DELIVERY

Volume 00, Number 00, 2025

Mary Ann Liebert, Inc.

Pp. 000–000

DOI: 10.1089/jamp.2024.0060

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scan code to access this article

and other resources online.

to understand how medical, technical, and environmental fac-

tors are prioritized when selecting an inhaler device. Our

ﬁndings revealed that both HCPs and patients prioritize

clinical considerations when prescribing or choosing an

inhaler. Environmental concerns ranked low, despite aware-

ness of the inhaler’s impact on climate change, underscoring

the importance of tailoring inhaler selection to patient needs

and promoting informed treatment decisions while transition-

ing towards newer, eco-friendly inhaler options as a progres-

sive step towards more sustainable health care.

Personalized health care

Patients and HCPs should have the autonomy to jointly

choose inhalers that best suit the medical needs, abilities, and

preferences of patients. Personalized health care promotes

better patient understanding and satisfaction, adherence, and

overall outcomes.

Patients should be trained to use their

inhaler correctly to avoid poorer disease control and over-

reliance on reliever medication.

Patients can also be offered

new inhaler technologies with smart features such as dose

counters, medication reminders, and educational applications,

which may improve adherence, technique, and health out-

comes.

Abrupt, unaccompanied switching of inhaler type

can lead to poor health outcomes requiring hospitalizations,

which have a marked environmental impact.

Recycling

We advocate for responsible inhaler disposal and recycling

to reduce environmental impact. Most HCPs and patients in our

previous study lacked access to recycling programs.

Collabora-

tive efforts between pharmaceutical companies and health care

systems are needed to establish recycling initiatives.

Greener inhalers

We support the development and adoption of inhalers

with lower GWP. Transitioning to greener inhalers should

not mandate a switch in the type of inhaler a patient currently

uses. Responsible choices support both patients and the

planet. We must evaluate the environmental impact of any

treatment, considering the overall impact. Industry advance-

ments are expected to produce new pMDIs with lower emis-

sions by 2025, making their environmental lifecycle impact

comparable to that of current DPIs.

REG advocates for a balanced approach that considers

patient-centered care, patient education, recycling, and adop-

tion of greener inhalers. We oppose arbitrary switching of

inhaler types for nonclinical reasons and advocate for pre-

scribing the right inhaler for the right patient while consider-

ing environmental responsibility.

Acknowledgments

The authors would like to thank Dr. Graham Lough for

hisworkontheﬁrst draft of the article, and the extended

network of the Respiratory Effectiveness Group.

Authors’ Contributions

All authors reviewed and approved the article.

Author Disclosure Statement

O.S.U. received grants from AstraZeneca, Boehringer

Ingelheim, Chiesi, Kindeva Drug Delivery and GlaxoSmithKline;

Consulting fees from AstraZeneca, Cipla and Mereo Biopharma;

Personal fees from Astra Zeneca, Boehringer Ingelheim,

Chiesi, GlaxoSmithKline, Mundipharma, Sandoz, Takeda,

Cipla, Covis, Novartis, Orion, Menarini, UCB, Trudell

Medical, Deva and Kamada. M.A.A. received personal fees

from Sanoﬁ, GlaxoSmithKline and Novartis; Meeting attend-

ance fees from Sanoﬁ, GlaxoSmithKline and AstraZeneca;

Participation on advisory board with Sanoﬁ, GlaxoSmithKline

and AstraZeneca. ERS Assembly 5 head, President of Inter-

national Society of Aerosols in Medicine, Chair of UK Inhaler

Group. K.A. declares no conﬂict of interest. A.A. received

consulting fees from GlaxoSmithKline, AstraZeneca, Sanoﬁ/

Regeneron and Viatrix; Speaker fees from GlaxoSmithKline,

AstraZeneca and Viatrix. F.B. received grants from MSD;

Consulting fees from Sanoﬁ, AstraZeneca, Menarini Inter-

national and GlaxoSmithKline; Speaker fees from AstraZeneca,

GlaxoSmithKline, Chiesi, Menarini Group and Sanoﬁ.G.W.C.

received speaker fees from Menarini, AstraZeneca, CellTrion,

Chiesi, Faes Farma, Firma, Genentech, Guidotti-Malesci,

GlaxoSmithKline, HAL Allergy, Innovacaremd, Novartis,

OM-Pharma, Red Maple, Sanoﬁ-Aventis, Sanoﬁ-Genzyme,

Stallergenes-Greer and Uriach Pharma; Meeting attendance

fees from Menarini, AstraZeneca, CellTrion, Chiesi, Faes

Farma, Firma, Genentech, Guidotti-Malesci, GlaxoSmithKline,

HAL Allergy, Innovacaremd, Novartis, OM-Pharma, Red

Maple, Sanoﬁ-Aventis, Sanoﬁ-Genzyme, Stallergenes-Greer

and Uriach Pharma. T. Lambert declares no conﬂicts of inter-

est; T. Lapperre received grants from Chiesi and Genentech;

Consulting fees from AstraZeneca, Boehringer Ingelheim,

Chiesi, GlaxoSmithKline, Novartis, Sanoﬁand ALK; Meeting

attendance fees from Sanoﬁand AstraZeneca; Participation on

advisory board for Chiesi, Sanoﬁ, AstraZeneca and Glaxo-

SmithKline. A.K. received consulting fees from ALK,

AstraZeneca, Boehringer Ingelheim, Covis, Eisai, Glaxo-

SmithKline, Idorsia, Merck, Moderna, Pﬁzer, Sanoﬁ, Trudel

and Valeo; Speaker fees from ALK, AstraZeneca, Boehringer

Ingelheim, Covis, Eisai, GlaxoSmithKline, Idorsia, Merck,

Moderna, Pﬁzer, Sanoﬁ, Trudel and Valeo; Boards/Societies

of Family Physician Airways Group of Canada and Asthma

Canada. M.M. received grants from Grifols; Consulting fees

from AstraZeneca, Atriva Therapeutics, Boehringer Ingelheim,

Chiesi, GlaxoSmithKline, CSL Behring, Inhibrx, Ferrer,

Menarini, Mereo Biopharma, Spin Therapeutics, Specialty

Therapeutics, BridgeBio, Palobiofarma SL, Takeda, Novartis,

Novo Nordisk, Sanoﬁ/Regeneron, Zambon and Grifols;

Speaker fees from AstraZeneca, Boehringer Ingelheim,

Chiesi, Cipla, GlaxoSmithKline, Menarini, Kamada, Takeda,

Zambon, CSL Behring, Specialty Therapeutics, Janssen,

Grifols and Novartis; Meeting attendance fees from Novartis,

Boehringer Ingelheim, Menarini and GlaxoSmithKline; Partici-

pation on data safety monitoring board for Moreo; NGP

received grants from Capricare, Nestle, Numil and Vianex;

Consulting fees from Abbott, Abbvie, Astra Zeneca, Glaxo-

SmithKline, HAL, Medscape, Menarini/Faes Farma, Mylan,

Novartis, Nutricia, OM Pharma and Regeneron/Sanoﬁ. C.K.R.

received consulting fees from Sanoﬁand AstraZeneca; Speaker

fees from AstraZeneca, GlaxoSmithKline, Novartis, Mundi-

pharma, Boehringer Ingelheim, Organon, Teva, and Sanoﬁ.

2LETTER TO THE EDITOR

N.R. received grants from Boehringer Ingelheim, Novartis,

GlaxoSmithKline and Pﬁzer; Consulting fees from Boehringer

Ingelheim, GlaxoSmithKline, AstraZeneca, Sanoﬁ,Chiesi,

Pﬁzer, Novartis, Teva, Bayer, Austral and Biosency; Speaker

fees from Boehringer Ingelheim, GlaxoSmithKline, Astra-

Zeneca, Sanoﬁ,Chiesi,Pﬁzer, Novartis, Teva, Zambon,

MSD and Menarini; Meeting attendance fees from Chiesi,

AstraZeneca and GlaxoSmithKline; ERS Council Chair.

J.B.S. received grants from Chiesi, GSK, Linde and Novartis;

Speaking fees/advisory board from Air Liquide, Almirall,

AstraZeneca, Boehringer Ingelheim, CHEST, Chiesi, CNPT,

ERS, FTH, Gebro, Grifols, GlaxoSmithKline, IHME, Laminar

Pharma, Linde, Lipopharma, Menarini, Mundipharma,

Novartis, OMS/WHO, Pﬁzer, ResApp, RiRL, ROVI, SEPAR,

Seqirus, WHO EUR, Takeda and Zambon.

Funding Information

This position statement was part of a research grant from

AstraZeneca, Boehringer Ingelheim, Chiesi and Kindeva

Drug Delivery.

References

1. The United Nations. MULTILATERAL Montreal Protocol on

Substances that Deplete the Ozone Layer (with annex). In:

Concluded at Montreal on 16 Sep tember 1987. 1987;1522

(26369).

2. Lough G, Bosnic-Anticevich S, Roche N, et al. Patient and

provider perspectives driving inhaler choice: Optimizing sus-

tainable healthcare. Chest 2024;166(5):934–937; doi: 10

.1016/j.chest.2024.06.3774

3. Scichilone N. Asthma control: The right inhaler for the right

patient. Adv Ther 2015;32(4):285–292; doi: 10.1007/s12325-

015-0201-9

4. Usmani OS, Lavorini F, Marshall J, et al. Critical inhaler errors

in asthma and COPD: A systematic review of impact on health

outcomes. Respir Res 2018;19(1):10–12; doi: 10.1186/s12931-

017-0710-y

5. Greene G, Costello RW. Personalizing medicine –could the

smart inhaler revolutionize treatment for COPD and asthma

patients? Expert Opin Drug Deliv 2019;16(7):675–677; doi:

10.1080/17425247.2019.1628017

Address correspondence to:

Omar S. Usmani, MBBS, PhD, FHEA, FRCP, FERS

National Heart and Lung Institute

Imperial College London

Dovehouse Street

London SW3 6LY

United Kingdom

E-mail: o.usmani@imperial.ac.uk

Abbreviations Used

CDC ¼Chloroﬂuorocarbon

COPD ¼Chronic obstructive pulmonary disease

DPI ¼Dry powder inhalers

GWP ¼Global warming potential

HCPs ¼Health care professionals

pMDI ¼Pressurized metered-dose inhalers

REG ¼Respiratory Effectiveness Group

LETTER TO THE EDITOR 3

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Respiratory Effectiveness Group Position Statement: Inhaler Choice: Balancing Personalized Health Care and Environmental Responsibility PDF Free Download

Respiratory Effectiveness Group Position Statement: Inhaler Choice: Balancing Personalized Health Care and Environmental Responsibility PDF free Download. Think more deeply and widely.

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