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Vol. 58. Issue 3.
Pages T287 (March 2022)
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Vol. 58. Issue 3.
Pages T287 (March 2022)
Letter to the Director
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[Translated article] Inhalation Devices and Climatic Change
Dispositivos de inhalación y cambio climático
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Jesús Molina París
Médico de Familia, Coordinador del Grupo de Enfermedades Respiratorias de semFYC, Centro de Salud Francia, Fuenlabrada, Madrid, Spain
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Arch Bronconeumol. 2022;58:28710.1016/j.arbres.2021.07.002
Jesús Molina París
Arch Bronconeumol. 2022;58:T28810.1016/j.arbres.2021.07.015
Carlos Cabrera López, Isabel Urrutia Landa, Carlos A. Jiménez-Ruiz
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Al Director,

I am writing in relation to the editorial that appeared in your journal entitled “SEPAR's year: Air quality. SEPAR statement on climate change”.1

In this article, Cabrera López, et al. claim that pulmonologists and all other professionals involved in respiratory medicine have a clear responsibility for the health of their patients, and this includes reducing the carbon footprint of the health sector as far as possible; I think we can all agree with this statement. SEPAR urges action to reduce the carbon footprint from both a personal and a professional point of view, and is committed to leading management-level actions aimed at achieving a more sustainable health system. One of the recommendations proposed by SEPAR to reduce climate change is to prioritize dry powder and fine mist inhalers over MDI, provided they meet patients’ needs.

Current consensus documents, guidelines, and available evidence in asthma and COPD indicate that insufficient or incorrect use of inhaled therapy is the main reason for lack of therapeutic compliance and control in asthma patients and persistent symptoms in COPD patients. Moreover, rescue therapy still accounts for more than half of the MDI inhalers used in Spain and is a marker of lack of control and risk of morbidity and mortality in asthmatic patients.2–4

The choice of inhaler is key in routine clinical practice, as patients may have specific difficulties (cognitive, neuromuscular, severe airflow limitation, etc.) or preferences that may hinder or prevent them from using a certain type of inhalation device properly.5,6

From my personal experience as a primary care physician with a particular interest in respiratory medicine, I believe that all these factors should lead us to reflect on the risk of prioritizing the type of inhalers used by asthmatic or COPD patients, unless such switches are performed for purely clinical reasons that consider the specific needs of each patient.

It is also important to consider the additional patient training that would be required if an expedited policy of switching devices were implemented, a situation that would also be aggravated by the logistical difficulties associated with the current pandemic situation. Any such changes, in my opinion, should be gradual.

References
[1]
C. Cabrera López, I. Urrutia Landa, C.A. Jiménez-Ruiz.
Año SEPAR por la calidad del aire. Papel de la SEPAR en favor del control del cambio climático.
Arch Bronconeumol, 57 (2021), pp. 313-314
[2]
Global Initiative for Asthma. Pocket guide for asthma management and prevention. Fontana, WI: GINA; 2021. https://ginasthma.org [02.06.21].
[3]
J. Domínguez-Ortega, F.J. Sáez-Martínez, J.T. Gomez-Sáenz, J. Molina-París, F.J. Álvarez-Gutiérrez.
El manejo del asma como enfermedad inflamatoria crónica y problema sanitario global: documento de posicionamiento de las sociedades científicas.
Semergen, 46 (2020), pp. 347-354
[4]
R. De Simón-Gutiérrez, A. Quijada Monzó, M.F. Ortiz Jiménez.
Descripción del uso de medicación inhalada de rescate en una población asmática atendida en el ámbito de la Atención Primaria. Estudio UMI-ASMA.
Semergen, 46 (2020), pp. 512-523
[5]
O.S. Usmani.
Choosing the right inhaler for your asthma or COPD patient.
Ther Clin Risk Manag, 15 (2019), pp. 461-472
[6]
D.B. Price, M. Román-Rodríguez, R.B. McQueen, S. Bosnic-Anticevich, V. Carter, K. Gruffydd-Jones, et al.
Inhaler errors in the CRITIKAL Study: type, frequency, and association with asthma outcomes.
J Allergy Clin Immunol Pract, 5 (2017), pp. 1071-1081.e9
Copyright © 2021. SEPAR
Archivos de Bronconeumología

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