Transforming Respiratory Care with Earlier Intervention

References

1. GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024. [Online]. Available at: [Last accessed: August 2024] 

2. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2022. Available at: [Last accessed: August 2024]

3. Wilkinson A, et al. Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe‒Based envirONmental cost of treatment (CARBON) study. Thorax. 2024 Feb 27;79(5):412-421.

4. GBD Chronic Respiratory Disease Collaborators. Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Respir Med. 2020 Jun; 8 (6): 585-596.

5. Quaderi, S. A., & Hurst, J. R. The unmet global burden of COPD. Glob Health Epidemiol Genom. 2018 Apr 6:3:e4

6. Bell J, et al. EXACOS CARBON: Describing the Greenhouse Gas Emissions of Healthcare Resource Utilization by Frequency and Severity of COPD Exacerbation in England. Poster Presentation at American Thoracic Society (ATS) international congress, 2024. 17-22 May.

7. ARUP. Health care’s climate footprint. [Online]. Available at:   [Last accessed: August 2024]

8. World Health Organization. Factsheet: Ageing and health. Available at: [Last accessed: August 2024]

9. CDC. Chronic Diseases and Cognitive Decline — A Public Health Issue. Available at: [Last Accessed August 2024]

10. Price D, et al. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014; 24: 14009.

11. Bloom CI, et al. Exacerbation risk and characterisation of the UK’s asthma population from infants to old age. Thorax. 2018; 73: 313-320.

12. Papi A, et al. Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma. J Allergy Clin Immunol Pract. 2018; 6: 1989-1998.

13. CDC. Uncontrolled Asthma Among Children With Current Asthma, 2018–2020. [Online]/Available at:  [Last accessed: August 2024]

14. Fletcher M, Hiles D. Continuing discrepancy between patient perception of asthma control and real-world symptoms: a quantitative online survey of 1,083 adults with asthma from the UK. Prim Care Respir J. 2013 Dec;22(4):431-8. 

15. Rupani H, et al. 2022. P145 What is the severe asthma patient journey to biologic initiation in UK severe asthma centres? Thorax. 77(Suppl 1): A159-A60.

16. Nwaru BI, et al. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020; 55 (4): 1901872.

17. Lloyd A, et al. The impact of asthma exacerbations on health-related quality of life in moderate to severe asthma patients in the UK. Prim Care Respir J. 2007; 16 (1): 22-7.

18. Price DB, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018; 11: 193–204.

19. EPR-3: Expert panel report 3. Guidelines for the Diagnosis and Management of Asthma 2007 (EPR-3). [Online]. Available at: [Last accessed: August 2024]

20. The Global Asthma Network. The Global Asthma Report 2022. [Online]. Available at:  [Last accessed: August 2024]

21. SMI. Decarbonising patient care pathways. [Online]. Available at: [Accessed August 2024].

22. Levy ML, et al. Global access and patient safety in the transition to environmentally friendly respiratory inhalers: the Global Initiative for Asthma perspective. Lancet. 2023;S0140-6736(23)01358-2.

23. Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag. 2019;15:461-472.

24. Usmani O, Levy ML. Effective respiratory management of asthma and COPD and the environmental impacts of inhalers. NPJ Prim Care Respir Med. 2023;33(1):24.

25. Bjermer L. The importance of continuity in inhaler device choice for asthma and chronic obstructive pulmonary disease. Respir. 2014;88(4):346-352.

26. Usmani O, et al. Consensus quality standard for implementing inhaler regimen switch in patients with respiratory disease. European Respiratory Society Congress 2023. Poster #PA4607.

27. Doyle S, et al. What happens to patients who have their asthma device switched without their consent? Prim Care Respir J. 2010; 19 (2): 131–139.

28. Adeloye D, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;Vol 10(5); 447-458 

29. World Health Organization. Global Health Estimates 2019: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. Global Summary Estimates. Geneva 2020. Available at [Last accessed: August 2024].

30. Make B, et al. Undertreatment of COPD: a retrospective analysis of US managed care and Medicare patients. Int J Chron Obstruct Pulmon Dis . 2012; 7: 1.

31. Ballreich JM, et al. Allocation of National Institutes of Health Funding by Disease Category in 2008 and 2019. JAMA Netw Open. 2021; 4(1): e2034890.

32. Centres for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease (COPD): National Trends. 2022. Available at: [Last accessed: August 2024].

33. Marshall D, et al. Trends in prevalence, mortality, and disability-adjusted life-years relating to chronic obstructive pulmonary disease in Europe: an observational study of the global burden of disease database, 2001-2019. BMC Pulm Med. 2022; 22:289.

34. Swart K, et al. Risk of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: results from the EXACOS-CV cohort study using the PHARMO Data Network in the Netherlands. Respiratory Research.(2023) Vol 24: 293 

35. Kunisaki KM, et al. Exacerbations of Chronic Obstructive Pulmonary Disease and Cardiac Events. A Post Hoc Cohort Analysis from the SUMMIT Randomized Clinical Trial. AM J Respir Crit Care Med. 2018;198(1):pp.51-57   

36. Halpin DMG, et al. Effect of a single exacerbation on decline in lung function in COPD. Respir Med. 2017; 128: 85-91.

37. Vogelmeier C, et al. Increased risk of severe cardiovascular events following exacerbations of COPD: a multi-database cohort study. [Poster] Presented at the European Respiratory Society International Congress 2023.

38. Lindenauer PK, et al. Risk Trajectories of Readmission and Death in the First Year After Hospitalization for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018;197(8):1009-1017.  

39. Ho TW, et al. In-Hospital and One-Year Mortality and Their Predictors in Patients Hospitalized for First-Ever Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Population-Based Study. PLOS ONE. 2014; 9 (12): e114866   

40. Patel J, et al.  Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States. Int J Chron Obstruct Pulmon Dis. 2014; 19:9:289-300.

41. Jansen EM, et al. Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers. J Thorac Dis. 2021 Jun;13(6):3846-3864.

42.  Scarffe, AD, et al. Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting. Cost Eff Resour Alloc. 2022;12;20(1):39.

43. Rabe KF, et al. Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very Severe COPD. N Engl J Med; 2020; 383: pp.35-48.

44. Pollack M, et al. Exacerbations and real-world outcomes (EROS) among patients with COPD receiving single inhaler triple therapy of budesonide/glycopyrrolate/formoterol fumarate [Poster Discussion]. Presented at the American Thoracic Society International Conference 2023 (19-24 May)

45. Bhutani M, et al. Quality Standard Position Statements for Health System Policy Changes in Diagnosis and Management of COPD: A Global Perspective. Adv Ther. 2022 Jun;39(6):2302-2322.

46. Miravitlles M, et al. Implementing an Evidence-Based COPD Hospital Discharge Protocol: A Narrative Review and Expert Recommendations. Adv Ther. 2023; 40,4236–4263 (2023).

47. Wilkinson TM, et al. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir; 2004;169:1298-303

48. Stolz D, et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet. 2022; 400 (10356);921-972.

49. World Health Organization. Factsheet: Climate change. Available at: [Last accessed August 2024]

50. World Health Organization. Ambient (outdoor) air pollution. [Online]. Available at:  [Last accessed August 2024]

51. Tennison I, et al. “Health care’s response to climate change: a carbon footprint assessment of the NHS in England.” Lancet Planetary Health. 2021; 5.2: e84-e92.​

52. AstraZeneca news release. AstraZeneca progresses Ambition Zero Carbon programme with Honeywell partnership to develop next-generation respiratory inhalers. [Online]. Available at:  [Last accessed August 2024]