Reducing the environmental impact of Metered Dose Inhalers with aflo, the automated inhaler technique platform

全球有超过7.5亿人患有哮喘和慢性阻塞性肺疾病（COPD）。在美国，这些疾病的症状得不到控制每年要花费340亿美元，在英国要花费15亿英镑。1956年引入了加压计量吸入器（MDIs）用于治疗哮喘和慢性阻塞性肺病，随后在20世纪80年代引入了干粉吸入器（dpi）。有证据表明，86%的吸入器使用者至少犯一次技术错误，优化给药以控制症状仍然是一个世界性问题。廉价的通用MDIs发挥着至关重要的作用，但它们使用的推进剂是温室气体（GHG）的重要贡献者。一种低碳推进剂HFA 152a正在开发中，预计在2025年推出。NHS净零目标将注意力集中在吸入器的全球变暖潜能值（GWP）上，将减少MDI的使用确定为一项政策目标。最近，人们开始关注这项政策对社会和环境的广泛影响。新出现的证据（Jeswani et al . 2019）表明，dpi对环境的更广泛影响——化石耗竭、陆地酸化、海洋和淡水富营养化、海洋和淡水生态毒性——大于mdi。NHS净零政策可能会产生意想不到的环境后果。此外，将MDI用户转换为dpi用户会带来患者风险。需要采取解决办法，处理更广泛的环境影响，同时确保如果吸入器选择不当，患者不会面临失去症状控制的风险。在之前Innovate UK支持的研发中，Respiratory Analytics设计并构建了一个深度技术平台aflo（tm）。它通过集成医疗级数据采集设备、用户共同设计的具有实时反馈的应用程序、临床医生门户和云托管数据分析中心，自动化正确的吸入器技术，以改善症状控制和患者自我管理，并提供量化的临床医生远程监控。与许多医药产品一样，关于呼吸吸入器对环境影响的数据有限。该项目旨在提供初步证据，证明带有aflo（tm）的吸入器自动化技术将通过优化低GWP“预防剂”（皮质类固醇）吸入器的药物沉积，控制症状，从而减少对高GWP“缓解剂”（短效β激动剂- SABA）吸入器的需求，降低吸入器对环境的影响。研究的第二个方面将调查吸入器的适当处置/再循环。我们的现实世界吸入器技术项目将有助于吸入器环境影响的非常重要的新兴研究机构。

Globally, more than 750M people live with asthma and chronic obstructive pulmonary disease (COPD). Uncontrolled symptoms of these conditions cost $34B in the US and £1.5B in the UK annually. Pressurised metered-dose inhalers (MDIs) were introduced in 1956 for the treatment of asthma and COPD, followed by Dry Powder Inhalers (DPIs) in the 1980's. Evidence shows that 86% of inhaler users make at least one technique error and optimising drug delivery to control symptoms remains a world-wide problem. Inexpensive, generic MDIs play a vital role but the propellants they use are a significant contributor to Green House Gases (GHG). A low carbon propellant, HFA 152a is in development, due to be introduced in 2025\.The NHS Net Zero target focused attention on the Global Warming Potential (GWP) of inhalers, identifying a reduction of MDI usage as a policy objective. Recently concerns have been raised about the wider societal and environmental impact of this policy. Emerging evidence (Jeswani et al 2019) suggests the wider environmental impact of DPIs - fossil depletion, terrestrial acidification, marine and freshwater eutrophication, marine and freshwater ecotoxicity - is greater than that of MDIs. The NHS Net Zero policy may have unintended environmental consequences. Additionally, switching MDI users to DPIs carries patient risk. Solutions are needed that address the broader environmental impact, while ensuring patients are not put at risk of losing control of symptoms if inhaler choice is not appropriate.In previous Innovate UK supported research and development, Respiratory Analytics designed and built a deep tech platform, aflo(tm). It automates correct inhaler technique via the integration of a medical grade data capture device, a user co-designed app with real-time feedback, a clinician portal and a cloud-hosted data analytics hub, to improve symptom control and patient self management and to provide quantified clinician remote monitoring.Like many pharmaceutical products there is limited data on the environmental impact of respiratory inhalers. This project seeks to provide primary evidence that automating inhaler technique for MDIs with aflo(tm) will lower the environmental impact of MDIs by optimising drug deposition of lower GWP 'preventer' (corticosteroid) inhalers, controlling symptoms, so reducing the need for high GWP 'reliever' (short acting beta agonist - SABA) inhalers. A second aspect of the research will investigate appropriate disposal/ recycling of MDIs. Our real world inhaler technique project will contribute to the very important emerging body of research into inhaler environmental impacts.