Written by: Robert Fogel, Vice President, US Medical Affairs, Respiratory & Immunology, AstraZeneca
Asthma and chronic obstructive pulmonary disease (COPD) affect millions of Americans and carry a significant clinical and environmental burden, particularly when not optimally managed. In the US alone, nearly 27 million people live with asthma and 16 million with COPD.1-4
People living with chronic respiratory diseases are especially vulnerable to environmental stressors, including air pollution and climate-related factors that can worsen symptoms and increase the risk of exacerbations.5,6 Poor disease control further compounds this burden, driving emergency visits and hospitalizations that contribute to higher healthcare utilization and associated emissions and are core to a vicious cycle of disease progression.7,8
Improving disease management is therefore critical for both patient outcomes and environmental impact. Inhaled therapies, including pressurized metered-dose inhalers (pMDIs), remain the foundation of care in both asthma and COPD. pMDIs account for 89% of inhaled therapy use in the US.9
AstraZeneca is advancing a commitment to improving the health of patients, society, and the planet through initiatives such as Ambition Zero Carbon and the development of next-generation propellants (NGPs) with near-zero global warming potential (GWP).10,11
A Commitment to Patients, Society, and the Planet
Addressing respiratory disease today requires a holistic approach that considers both health outcomes and environmental impact. AstraZeneca has committed to investing in sustainable solutions that support patients, their providers, and the healthcare system, while reducing emissions across the value chain.
As part of its Ambition Zero Carbon program, AstraZeneca has pledged $1 billion to reduce emissions across the research, development, manufacture and supply of medicines and reach net zero by 2045, including more than $500 million dedicated to transitioning inhaled respiratory medicines to use the NGP.11-13
This effort sits alongside broader initiatives to improve access and affordability, including a $35 [TJ1] per month cap on out-of-pocket costs for inhaled respiratory medicines for eligible patients in the US, including pMDIs using the NGP once approved.11Together, these programs reflect a coordinated strategy to improve patient outcomes while contributing to a more sustainable healthcare system.
Our ultimate commitment is to treat patients across the full spectrum of disease, evolving care to fit their needs by advancing next‑generation therapies, including biologics as well as novel oral and inhaled compounds.12
Environmental Impact on Vulnerable Respiratory Populations
People living with chronic respiratory diseases are particularly vulnerable to environmental stressors. Air pollution, including indoor and outdoor matter, is a major contributor to respiratory disease and a leading risk factor for COPD, particularly among those who have never smoked.3,5 Chronic exposure to low levels of air pollution can impair lung development, accelerate lung function decline, and increase the risk of disease progression.3
For individuals with asthma and COPD, poor air quality can worsen symptoms and significantly increase the risk of exacerbations and hospitalizations.14,15 When these conditions are poorly managed, the burden extends beyond individual patients. Exacerbations frequently lead to emergency visits and hospitalizations, increasing healthcare resource use and environmental impact.7,8 The emissions associated with a single high-intensity inpatient admission can be comparable to those from burning 10 gallons of gasoline.16,17
This dual burden highlights the importance of improving disease control as both a clinical and environmental priority, alongside efforts to reduce exposure to environmental risk factors.
The “Green Patient” and the Role of Inhaled Therapies
Poor disease control places an ongoing burden on patients and health systems.5,7,18 Multiple studies have demonstrated that the “greenest” patient is a well-controlled patient.2,19,20
Effective disease management reduces the need for acute care, including hospital visits and related travel, which contribute to emissions.16 The EXACOS CARBON study in the UK with COPD showed hospital-based care, which increased with exacerbation frequency and severity, was associated with significant emissions.19 Implementing guideline-directed therapy is central to achieving disease control, preventing exacerbations and hospitalizations, and reducing the overall carbon footprint of care.3,8,15
Inhaled medicines remain the foundation of respiratory care because they deliver medication directly to the lungs, improving symptoms, lung function, and reducing exacerbations and hospitalizations.21-23
Among inhaled medicine options, pMDIs play a critical role. They account for 89% of inhaled therapy use in the US and are particularly important for vulnerable populations, including children, older adults, and those with limited inspiratory flow.9,21,24,25
pMDIs use a propellant to deliver a precise dose of medication and remain an essential component of achieving disease control.26
Balancing Innovation and Patient Choice
Inhalers are not interchangeable, and treatment decisions should be guided by patient needs.27,28 Nonclinical switching between devices may disrupt disease control and lead to unintended consequences.29
A recent study found that a system-wide mandated nonclinical transition from pMDIs to a DPI was associated with increased emergency visits and hospitalizations, suggesting the potential for worsened outcomes and a higher overall carbon footprint of care.29
Maintaining patient choice and clinically driven treatment decisions remain essential to achieving optimal outcomes while minimizing avoidable healthcare utilization and emissions.30 Efforts to reduce environmental impact must be balanced with preserving appropriate and effective treatment options.31
Advancing Next-Generation Propellants
As part of its sustainability strategy, AstraZeneca is transitioning its pMDI portfolio to use a next-generation propellant (NGP) with near-zero GWP.10
This innovation aims to reduce emissions from inhaled therapies while maintaining clinical performance and accessibility for patients and clinicians. AstraZeneca’s NGP is approved across the EU and the UK with regulatory filings submitted in select markets including the US, demonstrating the momentum behind this transition.10,32
By advancing NGP technology, AstraZeneca is working to ensure that environmental progress does not come at the expense of patient care.
A Holistic Path Forward
Reducing the environmental impact of respiratory care requires improving disease control alongside lowering the carbon footprint of treatments. Poor disease control increases emissions through higher healthcare utilization, while effective management can reduce both clinical and environmental burden.7,18,19
AstraZeneca’s transition to pMDIs with next-generation, near-zero GWP propellants is part of a broader commitment to improving the health of patients, society, and the planet.10
Maintaining patient choice remains central to this effort, ensuring clinicians can select the most appropriate therapy for every individual’s needs.
To learn more about AstraZeneca’s commitment to sustainable care, visit here.
References
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2. CDC. Most Recent National Asthma Data. Accessed May 5, 2026. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm.
3. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Prevention, Diagnosis and Management of COPD: 2026 Report. Accessed May 5, 2026. https://goldcopd.org/2026-gold-report-and-%20pocket-guide/%20.
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10. AstraZeneca. Press release. Trixeo Aerosphere approved in the UK as first inhaled respiratory medicine using next-generation propellant with near-zero Global Warming Potential. Published May 12, 2025. Accessed May 5, 2026. https://www.astrazeneca.com/media-centre/press-releases/2025/trixeo-aerosphere-approved-in-the-uk-as-first-inhaled-respiratory-medicine-using-next-generation-propellant-with-near-zero-global-warming-potential.html.
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18. Sustainable Healthcare Coalition. Sustainable Care Pathways: Guidance Summary. Accessed May 5, 2026. https://shcoalition.org/wp-content/uploads/2024/01/Sustainable-Care-Pathways-Guidance-Summary-December-2023.pdf.
19. Bell J, Graul E, Nordon C, et al; EXACOS CARBON: describing the greenhouse gas emissions of healthcare resource utilization by frequency and severity of COPD exacerbation in England. Abstract. Am J Respir Crit Care Med. 2024;209:A2113.
20. Emeryk AW, Sosnowski T, Kupczyk M, et al; Impact of inhalers used in the treatment of respiratory diseases on global warming. Adv Respir Med. 2021;89:427–438.
21. Laube BL, Janssens HM, de Jongh FH, et al; What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37:1308–1331.
22. Papi A, Wise RA, et al; KALOS and LOGOS study investigators. Budesonide-glycopyrronium-formoterol fumarate dihydrate in uncontrolled asthma (KALOS and LOGOS): twin multicentre, double-blind, double-dummy, parallel-group, randomised, phase 3 trials. Lancet Respir Med. 2026;14(4):350-362.
23. Singh D, Martinez FJ, et al; Effect of Triple Therapy on Cardiovascular and Severe Cardiopulmonary Events in Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis of a Randomized, Double-Blind, Phase 3 Clinical Trial (ETHOS). Am J Respir Crit Care Med. 2025;211(2):205-214.
24. Mahler DA, Demirel S, Hollander R, et al; High Prevalence of Suboptimal Peak Inspiratory Flow in Hospitalized Patients With COPD: A Real-world Study. Chronic Obstr Pulm Dis. 2022;9(3):427-438.
25. Keeley D, Partridge M; Emergency MDI and spacer packs for asthma and COPD. Lancet Resp Med. 2019;7:380-382.
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27. Usmani OS, Roche N, van Boven JF, et al; Consensus quality standard for implementing inhaler regimen switch in patients with respiratory disease. Poster presented at the European Respiratory Society (ERS) Congress; September 9-13, 2023; Milan, Italy. Abstract 4607.
28. Bjermer L; The importance of continuity in inhaler device choice for asthma and chronic obstructive pulmonary disease. Respiration. 2014;88:346–352.
29. Rabin AS, Seelye SM, Weinstein JB, et al; Budesonide-Formoterol Metered-Dose Inhaler vs Fluticasone-Salmeterol Dry-Powder Inhaler. JAMA Intern Med. 2025;185(8):1005–1013.
30. Usmani OS, Levy ML; Effective respiratory management of asthma and COPD and the environmental impacts of inhalers. NPJ Prim Care Respir Med. 2023;33:24.
31. Aurivillius M, Bednarczyk A, Kokot M, et al. Relative bioavailability of budesonide/glycopyrrolate/formoterol fumarate triple therapy delivered using next generation propellants with low global warming potential. Pulm Pharmacol Ther. 2023;83:102245.
32. AstraZeneca. Trixeo Aerosphere receives positive EU CHMP opinion as first inhaled medicine using next-generation propellant with near-zero Global Warming Potential. Published July 25, 2025. Accessed May 5, 2026. https://www.astrazeneca.com/media-centre/press-releases/2025/trixeo-aerosphere-receives-positive-eu-chmp-opinion-first-inhaled-medicine-using-next-generation-propellant-with-near-zero-global-warming-potential.html.