Introduction: Single inhaler triple therapy (SITT) is used as maintenance therapy in servereCOPD. SITT is available as dry-powder inhalers (DPIs) and pressured metered-dose inhalers(pMDIs). pMDIs have a more harmful impact on the climate compared to DPIs.
Aim: To map changes in the prescription of SITT in Sweden and to compare regionaldifferences regarding the climate impact of the treatments.
Methods: A mapping of recommended SITT DPIs (ATC-code: R03AL08) and pMDIs (R03AL09,R03AL11) in all 21 regions. Changes in SITT prescriptions between 2018 and 2022 were retrieved from the national statistical database and used for the climate impact calculations.The regional drug committees were interviewed to discuss factors influencing theprescription of inhalers.
Results: Ninety percent of the regions (n=19/21) recommended DPI as the first choice SITT. The use of pMDIs increased from 0.6 to 3.3 patients per 1,000 inhabitants and DPIs from 0.3to 2.2 patients per 1,000 inhabitants during the same period. The climate impact from SITT was significantly higher in 2022 than in 2018. The climate impact for DPIs increased from 9,370 kg CO2e in 2018 to 84,297 kg CO2e in 2022. The climate impact for pMDIs increased from 291,630 kg CO2e in 2018 to 2,765,651 kg CO2e in 2022. Increased recognition of SITT and annual treatment recommendation updates were factors influencing the SITT prescriptions found in the interviews.Conclusion: The SITT use in Sweden has increased since 2018. DPIs are widelyrecommended but pMDIs are more common. There are large regional differences in theprescription and climate impact, and most of the climate impact originates from the pMDIs. Follow-up of the SITT prescriptions at a regional level is proposed to reduce the climateimpact.