The Spanish Society of Family and Community Medicine (semFYC) Has published ‘Dos and don’ts in planetary health’, a document prepared by Planetary Health Working Group of the scientific society of Primary Care and that seeks to be a guide “as practical as possible” for physicians at the first level of care.
“The objective is that you apply it in your day to day: in the routine of your health center or office, when you value your patients, when recommending prevention and health promotion activities, when prescribing or in the activities with your community”, they point out, adding that “the time has come to include the perspective of planetary health in your daily life, because there is no PLANET B“.
Among the ten pieces of advice provided by specialists in Family and Community Medicine (FCM), the fifth is committed to “do not prescribe pMDI inhalers if there is a better alternative”. The authors of this section Anna Fernandez Ortiz Y Maria del Campo Gimenezexpress that “all drugs have an impact on the environment: the carbon footprint production, storage, packaging, transport and waste management”.
It is estimated that the change from a pMDI system to DPI or SMI, keeping the same active ingredient, represents a reduction of the carbon footprint of 95-98% per inhaler
However, they add, inhalers have another added factor: the propellant of pressurized systems. pMDI (Pressurized Metered Dose Inhaler), the gases hydrofluorocarbons (HFCs), with a more powerful greenhouse effect than CO2.
In Spain, pMDIs represent close to 50% of the total bronchodilators used, which is equivalent to 400,000 tons of CO2. Hence the importance of trying to minimize the use of this type of pMDI inhalers in favor of systems that do not use greenhouse gases, such as dry powder inhalers (Dry Powder Inhaler, DPI) and the fine mist inhalers (Soft Mist Inhaler, SMI).
It is estimated that the change from a pMDI system to DPI or SMI, keeping the same active principle, supposes a carbon footprint reduction of 95-98% per inhaler. For example, among short-acting beta-agonist drugs, one application of salbutamol in a pMDI device is equivalent to 60.4 g CO2 eq; taking into account that up to 8 daily applications can be used, it would be equivalent to 176.37 kg CO2 eq per year, which is the same as produced a car trip of 978.5 km.
If the characteristics of the patient allow it, it is recommended to prescribe DPI and SMI, with a lower carbon footprint (up to 18 times, in the case of IPRs). These devices are just as effective Y cost-effective than PMDs.
If the characteristics of the patient allow it, it is recommended to prescribe DPI and SMI, with a lower carbon footprint (up to 18 times, in the case of DPI)
The prescription of the type of device will always be made taking into account the patient characteristics and its preferences regarding the type of device, so it is useful to have support materials for shared decision making.
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