Browsing by Author "Brightling, C"

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    Global access and patient safety in the transition to environmentally friendly respiratory inhalers: the Global Initiative for Asthma perspective
    Levy, ML; Bateman, ED; Allan, K; Bacharier, LB; Bonini, M; Boulet, LP; Bourdin, A; Brightling, C; Brusselle, G; Buhl, R; Chakaya, MJ; Cruz, AA; Drazen, J; Ducharme, FM; Duijts, L; Fleming, L; Inoue, H; Ko, FWS; Krishnan, JA; Masekela, R; Mortimer, K; Pitrez, P; Salvi, S; Sheikh, A; Reddel, HK; Yorgancioglu, A
    Climate change and its impacts on the health of our planet and its people are, deservedly, on centre stage in international discourse, and have prompted critical evaluation of all human activities that could lessen the degree and progression of these effects. Health care, too, is under scrutiny for its contribution to climate change. Among the many issues is the global warming potential of gases in medical devices, including fluorinated gas propellants in pressurised metered-dose inhalers (pMDIs) that are often used for the treatment of airway diseases; these contribute a small but substantial proportion of global greenhouse gas emissions (estimated as <0 center dot 1%). 1-9 Many countries, including the USA, the UK, and several in mainland Europe, have developed policies to reduce the carbon footprint of inhalers. The chief measures proposed are to replace harmful propellants, such as hydrofluoroalkane-134a and hydrofluoroalkane-227ea,1,2 with safer alternatives that are under development; 4,10,11 in the meantime to choose pMDIs that have lower fluorinated gas content;12 and to encourage a switch to dry-powder inhalers (DPIs), which do not contain propellants (assuming that the patient can use the relevant inhaler correctly).12,13 At the same time, international action is being taken to limit use of perfluoroalkyl and polyfluoroalkyl substances (PFAS),14 a large and diverse group of chemicals that are widely used in consumer products and industry, and some of which have significant toxicity and accumulate in the environment over time. Actions to limit PFAS, if worded too broadly, could affect supply of some new propellants that have low global warming potential and no evidence of toxicity or accumulation over time.
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    Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update
    Levy, ML; Bacharier, LB; Bateman, E; Boulet, LP; Brightling, C; Buhl, R; Brusselle, G; Cruz, AA; Drazen, JM; Duijts, L; Fleming, L; Inoue, H; Ko, FWS; Krishnan, JA; Mortimer, K; Pitrez, PM; Sheikh, A; Yorgancioglu, A; Reddel, HK
    The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with mild asthma) as combination ICS-formoterol taken as needed for symptom relief. For patients with moderate-severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS-formoterol. Asthma treatment is not one size fits all; GINA recommends individualized assessment, adjustment, and review of treatment. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care. While the GINA strategy has global relevance, we recognize that there are special considerations for its adoption in low- and middle-income countries, particularly the current poor access to inhaled medications.