Adherence to NICE Guidelines for Chronic Obstructive Pulmonary Disease Can Improve Patient Outcomes and Reduce Carbon Footprint When Compared With Current Clinical Practice

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) has an increasing global burden and pharmacological therapy is the cornerstone of disease management, reducing symptoms and frequency/severity of exacerbations. Long-acting muscarinic antagonists (LAMA), long-acting β-agonists (LABA), and inhaled corticosteroids (ICS) are commonly used alone or in combination. Inhaled treatments comprise pressurized metered-dose inhalers, dry powder inhalers, and soft-mist inhalers, each with different carbon footprints. National recommendations often differ from real-world prescribing practices. This study aimed to model the environmental impact of COPD treatment pathways in the UK, comparing National Institute for Health and Care Excellence (NICE) guidelines to current clinical practice.

METHODS: COPD treatment was mapped over one year using published prescribing patterns or NICE recommendations (NG115) in the UK. Patients were categorized based on the number/severity of prior COPD exacerbations and current symptom severity, following the GOLD ‘ABCD’ classification. Treatment covered maintenance therapy with LAMA, LABA and ICS. Carbon emissions for GP visits, specialist care, emergency room visits, hospitalizations, and travel were sourced from shcoalition.org. Carbon emissions for each medication class were calculated from published information. The environmental cost of treatment was estimated using published clinical outcomes, including changes in rates of moderate and severe COPD exacerbations and mild/moderate and severe pneumonia episodes.

RESULTS: Treating COPD as per NICE recommendations could potentially save ~19,959 tonnes of carbon dioxide equivalents (CO₂e) when compared with current clinical practice. Medication-associated carbon emissions (18,261 tonnes CO₂e) are associated with 91.5% of savings, attributable to increased usage of LAMA/LABA inhalers. Reducing severe pneumonia episodes saves 1,692 tonnes CO₂e, with fewer hospitalizations. Environmental impact associated with COPD exacerbations remain similar with both treatment practices (9,786 vs 9,856 tonnes CO₂e).

CONCLUSIONS: Following the latest evidence-based NICE-recommended prescribing practices could reduce environmental impact for patients with COPD due to decreased medication emissions and fewer pneumonia hospitalization episodes.