1
|
Owens S, Morris K, Hurley E, O'Reilly K, O'Callaghan J, Allman J, Linehan D, McDonald M, Green S. Estimating the national carbon footprint of inhalers in healthcare. Ir J Med Sci 2023; 192:2251-2253. [PMID: 36482282 DOI: 10.1007/s11845-022-03234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metered dose inhalers (MDIs) contain greenhouse gases which have a disproportionate effect on the carbon footprint of healthcare. There are more environmentally friendly alternatives such as dry powder inhalers (DPIs) or soft mist inhalers (SMIs). AIMS This study aims to approximate the carbon footprint of inhalers dispensed in Irish healthcare. METHODS Health Market Research data was used to examine the number of inhalers sold in Ireland in 2019 via dispensing data from pharmacy IT systems. The carbon footprint per inhaler data was then used to calculate the total carbon footprint of each drug class, and an estimate for the total carbon footprint of inhalers sold in Ireland was generated. RESULTS 4,427,287 inhalers were dispensed in Ireland in 2019 of which 2,608,433 (59%) were MDIs and 1,818,854 were DPIs/SMIs (41.1%). The total carbon equivalent of these inhalers was estimated to be 54,765 tCO2. MDIs account for 59% of inhaler units dispensed but account for 97% of inhaler-related carbon emissions. CONCLUSION Targeting inhaler prescribing offers the potential to significantly improve the carbon footprint of Irish healthcare. Establishing the current carbon footprint of the inhalers that are prescribed, dispensed, and disposed in Ireland is a necessary baseline to inform moving towards a net zero health service.
Collapse
Affiliation(s)
| | | | - Eimir Hurley
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Katherine O'Reilly
- Department of Respiratory Medicine, Mater Misericordiae University Hospital and School of Medicine, UCD, Dublin, Ireland
| | - Johanna O'Callaghan
- Respiratatory Integrated Care, Dublin North City & County and Connolly Hospital Blanchardstown, Dublin, Ireland
| | | | | | - Mary McDonald
- Paediatric Respiratory Department, CHI at Tallaght University Hospital, Tallaght Dublin 24, Ireland
| | - Sandra Green
- Waterford University Hospital, Waterford, Ireland
| |
Collapse
|
2
|
Liu C, Yang N, Song Y, Wang L, Zi J, Zhang S, Dunkin D, Busse P, Weir D, Tversky J, Miller RL, Goldfarb J, Zhan J, Li XM. Ganoderic acid C1 isolated from the anti-asthma formula, ASHMI™ suppresses TNF-α production by mouse macrophages and peripheral blood mononuclear cells from asthma patients. Int Immunopharmacol 2015; 27:224-31. [PMID: 26004313 DOI: 10.1016/j.intimp.2015.05.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/28/2015] [Accepted: 05/11/2015] [Indexed: 01/07/2023]
Abstract
Asthma is a heterogeneous airway inflammatory disease, which is associated with Th2 cytokine-driven inflammation and non-Th2, TNF-α mediated inflammation. Unlike Th2 mediated inflammation, TNF-α mediated asthma inflammation is generally insensitive to inhaled corticosteroids (ICS). ASHMITM, aqueous extract of three medicinal herbs-Ganoderma lucidum (G. lucidum), Sophora flavescens Ait (S. flavescens) and Glycyrrhiza uralensis Fischer (G. uralensis), showed a high safety profile and was clinically beneficial in asthma patients. It also suppresses both Th2 and TNF-α associated inflammation in murine asthma models. We previously determined that G. uralensis flavonoids are the key active compounds responsible for ASHMITM suppression of Th2 mediated inflammation. Until now, there are limited studies on anti-TNF-α compounds presented in ASHMITM. The objective of this study was to isolate and identify TNF-α inhibitory compounds in ASHMITM. Here we report that G. lucidum, but not the other two herbal extracts, S. flavescens or G. uralensis inhibited TNF-α production by murine macrophages; and that the methylene chloride (MC)-triterpenoid-enriched fraction, but not the polysaccharide-enriched fraction, contained the inhibitory compounds. Of the 15 triterpenoids isolated from the MC fraction, only ganoderic acid C1 (GAC1) significantly reduced TNF-α production by murine macrophages (RAW 264.7 cells) and peripheral blood mononuclear cells (PBMCs) from asthma patients. Inhibition was associated with down-regulation of NF-κB expression, and partial suppression of MAPK and AP-1 signaling pathways. Ganoderic acid C1 may have potential for treating TNF-α mediated inflammation in asthma and other inflammatory diseases.
Collapse
Affiliation(s)
- Changda Liu
- Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, NY 10029, United States
| | - Nan Yang
- Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, NY 10029, United States
| | - Ying Song
- Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, NY 10029, United States
| | - Lixin Wang
- Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, NY 10029, United States; Shanghai Municipal Hospital of Traditional Chinese Medicine affiliated with Shanghai TCM University, China
| | - Jiachen Zi
- Department of Biological Engineering, Utah State University, 4105 Old Main Hill, Logan, UT 84322, United States
| | - Shuwei Zhang
- Department of Biological Engineering, Utah State University, 4105 Old Main Hill, Logan, UT 84322, United States
| | - David Dunkin
- Pediatric Gastroenterology, Pediatric Department, Icahn School of Medicine at Mount Sinai, NY 10029, United States
| | - Paula Busse
- Immunology Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, United States
| | - David Weir
- Division of Pulmonary, Critical Care Medicine, and Sleep Medicine , Mount Sinai Medical Center, NY 10029, United States
| | - Jody Tversky
- Division of Allergy & Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, MD 21224, United States
| | - Rachel L Miller
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University, New York, NY, 10032, United States; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University, New York, NY 10032, United States; Department of Environmental Health Sciences, Columbia University, New York, NY, 10032, United States
| | - Joseph Goldfarb
- Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, NY, 10029, United States
| | - Jixun Zhan
- Department of Biological Engineering, Utah State University, 4105 Old Main Hill, Logan, UT 84322, United States.
| | - Xiu-Min Li
- Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, NY 10029, United States.
| |
Collapse
|