Year: 2026
Type: article
Abstract: every extra SABA canister both an avoidable clinical risk and an avoidable source of carbon emissions.6,7 In short, the same prescribing patterns that worsen outcomes also magnify the carbon footprint of asthma care, turning SABA overuse into a dual burden for both clinical outcomes and environmental sustainability.This review, therefore, asks a practical question with system-wide implications: can we redesign asthma care to improve outcomes and simultaneously shrink its carbon footprint?We synthesize global and Indian evidence on SABA overuse, emphasizing its dual consequences for health and climate.Further, we examine how transitioning to ICS-formoterol-based maintenance and reliever therapy (MART) offers a unified, high-impact strategy to mitigate these challenges.We move from the "why"-the burden and risks of SABA overuse to the "how"-a scalable, evidence-based alternative that reduces both exacerbations and carbon emissions. IntroductIonAsthma remains a global public health challenge, causing substantial avoidable morbidity and mortality across the globe.Overreliance on short-acting β 2 -agonists (SABAs), the familiar "blue inhaler," has long been considered harmless.Emerging high-quality evidence demonstrates that frequent SABA use is not just a habit; it is a health hazard.Robust evidence now shows that frequent SABA use (typically ≥3 canisters per year) is a reliable marker of poor disease control, with a higher risk of acute exacerbations and mortality, and increased healthcare resource utilization, compared with lower use.1,2 Reflecting this, the Global Initiative for Asthma (GINA) no longer recommends SABA-only strategies and strongly endorses anti-inflammatory reliever regimens [AIR, inhaled corticosteroid (ICS)-formoterol, or ICS-SABA] even for mild asthma, shifting the therapeutic paradigm from "relief first" to "treat the underlying inflammation."3,4 Together, these developments reposition the "reliever" not as a standalone quick fix, but as a vehicle for delivering anti-inflammation at every symptom-driven dose.Yet, one dimension of this problem remains underexplored and seldom discussed: its environmental cost.Recent nationalscale analyses in the USA show the release of nearly 24.9 million metric tons of CO 2 emissions (CO 2 e) from inhalers over a decade (2014-2024).Ninety-eight percent of the total inhaler-related emissions were from pressurized metered-dose inhalers (pMDIs), with SABA dominating the footprint.5 This is of particular concern in India, where multiple studies have highlighted high SABA overuse and severe underuse of ICSs, with estimates suggesting that more than 90% of patients do not receive adequate ICS therapy; a gap linked to India's disproportionate share of global asthma deaths (~42%).Although comparable countrywide inhaler emission estimates are not yet available for India, the convergence of high SABA demand and low ICS use strongly suggests a similar or higher environmental burden, making
Source: Journal of PACS
Institutions: Bombay Hospital, Apollo Hospitals, Alkem (India)
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7167454875