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Outlining a road map to sustainable asthma care

A new report has made recommendations for reducing the carbon footprint of asthma care, while also improving patient outcomes, writes Anthony Flynn, Director of Health Knowledge and Translation at Asthma Australia.


Anthony Flynn writes:

The National Health and Climate Strategy was released in December 2023 to help mitigate the healthcare sector’s contribution to climate change and in turn improve the health of our communities. One of the key actions in the Strategy is a commitment to improving respiratory health outcomes and reducing greenhouse gas emissions from respiratory inhalers.

Asthma Australia wanted to ensure that this action was approached with improved asthma management as the priority, supported by environmental co-benefits.

Asthma Australia and Deakin University’s Institute for Health Transformation (IHT) partnered to harness the collective wisdom and experience of Australia’s most important healthcare players to create a roadmap to bring the Australian Government’s strategy to life.

Fifty organisations representing consumers, health care professionals, research, industry, peak organisations and government took part in two round tables.

A commitment to developing a systematic approach to identify actions for reducing health sector emissions was front and centre. This deliberate and consultative approach put people living with asthma at the heart of the conversation and prioritised improving their asthma management with emissions reduction as a co-benefit.

The roundtable discussions were structured to understand why asthma care has a disproportionately large climate footprint. Priorities were to identify the opportunities and barriers to improving care, reducing emissions and developing collaborative goals and actions.

The process started at the end of 2023 and culminated in the launch of the National Sustainable Asthma Care Roadmap – Roundtable Report on 18 September 2024 by the Hon Ged Kearney, Assistant Minister for Health and Aged Care.

Anthony Flynn

Strategic approach required

The Roadmap supports the development of a national implementation plan. When it comes to transitioning to low greenhouse gas emission asthma care, tackling the issue of hydrofluorocarbon propellants used in current ‘asthma puffers’, called pressurised metered-dose inhalers (pMDI), is critical.

These propellants are potent greenhouse gases and are responsible for around 90 percent of the asthma healthcare footprint in the UK.

While a comprehensive assessment of Australia’s total asthma care footprint is required for the greenhouse impact of the approximately 25 million inhalers sold in Australia each year, we do know that around 80 percent of these are high global warming potential inhalers.

They are estimated to contribute more than 600,000 tonnes of carbon dioxide equivalent (CO2e) to the atmosphere each year, similar to the emissions of 350,000 vehicles.

Reducing the high rate of poorly controlled asthma and mitigating the environmental impact of pressurised metered-dose inhalers used to treat asthma represents a major unmet need.

Compelling evidence shows that transitioning to anti-inflammatory asthma medication regimens delivered using low-carbon devices can improve person-centred asthma outcomes while simultaneously reducing greenhouse gas emissions.

A coordinated and strategic approach is required to expedite the translation of this evidence into policy and practice.

HCRU: Higher healthcare resource use; SABA: Short-acting beta 2-agonists;  ICS: inhaled corticosteroids

Areas for action

The Roadmap presents eight goals that provide a process for transitioning asthma care in Australia to a higher quality and more environmentally sustainable model.

These are to:

  1. Establish a data dashboard to display the national indicators of high-quality asthma care and decarbonisation trends. This will help monitor and evaluate progress towards improved asthma care and reduced associated greenhouse gas emissions.
  2. Establish processes and resources to support regular updates to the national asthma guidelines, which provide best-practice, evidence-based guidance translated into practical advice for primary care health professionals.
  3. Increase clinician knowledge and adoption of best practice in asthma care and sustainability, enabled by digital clinical decision-making as well as management and prescribing tools, in order to avoid overuse of pressurised metered-dose inhalers and reduce asthma exacerbations.
  4. Inform people with asthma about how to improve their asthma control and educate about options to reduce greenhouse gas emissions from inhalers where suitable devices are available. The aim is to increase consumer knowledge, empowerment and shared decision-making.
  5. Reduce the imbalance between cost and ease of access to pressurised metered-dose inhalers compared with more effective medications. This also supports the implementation of evidence-based guidelines and thereby improves safety and disease control.
  6. Support research to implement and evaluate high-quality sustainable asthma care, with the goal of informing a national implementation of evidence-based, guideline-concordant, low-carbon asthma care.
  7. Reduce greenhouse gas emissions by minimising residual hydrofluorocarbon leakage from discarded asthma inhalers, specifically targeting propellant leakage from pressurised metered-dose inhalers disposed of in household waste.
  8. Support governments in developing a ‘health in all policies’ approach to reducing the modifiable inducers and triggers of asthma. This includes improving air quality and reducing asthma triggers while also improving respiratory health for all.

There were significant contributions from a wide range of organisations in the Acknowledgements page in the Roadmap. This demonstrates the level of engagement but also good will for this work, which has led to tangible outcomes.

It was a real example of how when sector works together towards a common goal, a seemingly impossible goal becomes not only achievable, but one for which out-of-the-box solutions can be found.

Bringing together the views and input of the 50 stakeholders was a significant task and it only happened due to the leadership and real passion for the issue from IHT Deakin University’s Dr Mike Forrester.

Next steps

Asthma Australia wants to ensure the momentum built through this process is actioned through an implementation plan and is looking to work with stakeholders who contributed to the Roadmap, as we would hope other parties – including government – can resource and take on progressing goals and actions.

This includes establishing a body to develop an implementation plan, foster communication and ensure a collaborative and efficient process. A key piece of work identified is also an economic evaluation of the costs and potential savings for the health sector and broader community in making a transition to high-value care, including assessment of the associated social, health and environmental benefits.

Asthma Australia will be putting proposals to the Australian Government for funding through the Federal Budget for 2025-26. We are also working to bring together key report contributors in the next couple of months to discuss a plan for progressing implementation.

There is a real opportunity with the Roadmap to improve the lives of people living with asthma. Asthma Australia hopes to help shepherd the Roadmap through to actions and tangible results as we advocate for the nearly 2.8 million Australians with asthma who deserve great, sustainable healthcare.

The full report is available here.

Author details

Anthony Flynn is the Director of Health Knowledge and Translation at Asthma Australia. In this role he oversees Asthma Australia’s research program, strategic evaluation plans and supervises the quality development of consumer information and education resources. Anthony has a Masters Degree in Social Sciences and is a registered nurse who specialised in critical care nursing. He is responsible for connecting the need of the person with asthma with strategic research and evaluation decisions and the translation of these into consumer benefit.

Disclosure statement from report

Deakin University and Asthma Australia developed this workshop series independently under a research agreement. In compliance with Medications Australia’s code of conduct, Asthma Australia secured funding for this initiative through unrestricted grants from AstraZeneca, Chiesi Australia, GSK and Orion Pharma Australia. Deakin University provided in-kind support, contributing additional resources and expertise.


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