Many Australians have asthma that is not well controlled. Better asthma management will not only reduce symptoms and help prevent severe exacerbations, but it could also help improve the health of our environment.
Australian studies have reported high rates of poor asthma symptom control, associated with under-use of inhaled corticosteroids (ICS)1 and over-reliance on short-acting beta2 agonists (SABAs). Salbutamol via pressurised metered-dose inhaler (pMDI) is by far the most common reliever medicine used in Australia, with over 5 million prescribed inhalers dispensed per year, plus an estimated 6 million salbutamol pMDIs sold over the counter annually.
Overuse of short-acting beta2 agonists is risky. Dispensing of three or more 200-dose salbutamol canisters per year (equivalent to more than daily average use) is associated with increased risk of severe asthma exacerbations.
Overuse of salbutamol pMDIs is also a problem for the environment. Poorly controlled asthma has a larger carbon footprint than well-controlled asthma, due partly to healthcare utilisation, but mainly to use of SABA pMDIs. All asthma inhalers have an impact on the environment, but pMDIs have a much larger impact than other inhalers because they contain hydrofluorocarbon propellants, which are released during use and through leakage after disposal. Annual Australian greenhouse gas emissions from SABA inhalers have been estimated to be equivalent to over 350,000 tonnes of carbon dioxide12 – as polluting as driving a petrol car from Sydney to Perth more than 360,000 times.
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