Written by:
Robert Fogel
Vice President, Global Medical Affairs, Respiratory & Immunology, AstraZeneca
We are deeply committed to transforming respiratory care. As leaders in respiratory for more than five decades, we continue to drive innovation that benefits patients, society and the planet, affirmed by our presence at this year’s European Respiratory Society Congress.
As a founding partner of the International Respiratory Coalition (IRC) alongside the European Respiratory Society (ERS), patient groups and other industry partners, as well as our active participation in the Speak Up for COPD coalition, we seek to improve respiratory health through policy prioritisation, the introduction of national respiratory strategies and updating of guidelines and encouraging greater implementation of evidence-based guidelines to improve patient outcomes.
We are also passionately focused on continued scientific and medical innovation pursuing a full, integrated, portfolio so that healthcare professionals can offer patients more improved options to manage their condition, including therapies that treat the underlying drivers of their disease.
We know our work to improve outcomes is vital, not only to improve the lives of patients – ensuring they get the right treatment at the right time – but also to reduce the environmental burden of care. We believe that earlier intervention, proactive management and adopting global recommendations such as GOLD and GINA are key to preventing exacerbations, hospitalisations and ultimately death from respiratory diseases.1,2 Well-controlled respiratory disease has the potential to combine benefits for both patients and the environment by reducing the carbon footprint of care and improve the lives of millions around the world.3
Respiratory diseases are complex, difficult to treat, and significant unmet needs persist
Nearly 550 million people worldwide are affected by chronic respiratory diseases,4 including asthma and COPD, which are associated with high morbidity, mortality, delayed diagnosis / treatment leading to sub-optimal disease control, and its associated risks, as well as greater healthcare resource utilisation (HCRU).3,5-7 By 2030, one in six people will be over the age of 60.8 As the populations rapidly age, the prevalence of poorly controlled disease is also likely to increase in many countries,9 putting further strain and demand on healthcare systems.3 This has an obvious societal and economic impact and is predicted to lead to the worsening of respiratory diseases over the next 10 years. Unfortunately, few countries have national respiratory strategies to prioritise these issues, placing increased pressure on already stretched health systems.
Working towards remission as an achievable treatment goal in asthma
Helping patients achieve remission in asthma is central to our ambition.
All patients, regardless of disease severity, are at risk of asthma attacks particularly if they remain uncontrolled.10-12 Across the UK, Europe and USA, approximately half of those with asthma are poorly controlled10,13,14 with many patients waiting months to years to see an asthma specialist.15 This leaves them at risk of irreversible damage from inadequately managed asthma,16,17 as well as the widely acknowledged side effects of repeated or prolonged oral corticosteroid usage.2,18,19 This places additional pressure on stretched healthcare resources and costs.20
To combat this preventable situation, the Severe Asthma Policy Group developed a new call to action earlier this year, urging governmental institutions and policymakers to prioritise severe asthma care. Optimising care by driving earlier intervention and implementing evidence-based guidelines can reduce exacerbations, improve patient outcomes and may also decrease the overall carbon footprint through fewer hospitalisations, less medication use and fewer sick days.2,21-27
Addressing cardiopulmonary risk to reduce COPD mortality
COPD is a major public health threat28 and a leading cause of death globally.29 Despite this, it is often under-prioritised, underfunded and undertreated.5,30, 31
To reduce the unacceptably high mortality rates that have remained stagnant in COPD for over 20 years,29,30,32,33 there has been a recent groundswell of support to address the elevated risk that people who are diagnosed with COPD have of both lung and heart events – cardiopulmonary risk.34 This risk increases following an exacerbation, and this elevated risk may persist for up to a year.35-37 Sadly, approximately one in five patients die within a year of their first hospitalisation resulting from an exacerbation.38-39
This makes addressing cardiopulmonary risk – from the first COPD diagnosis or hospital visit – crucial. Early intervention, proactive care, implementation of guidelines and evidence-based medicine are key to preventing exacerbations and reducing the irreversible impact COPD can have.40-44 These strategies will lead to more patients with well controlled disease, improving outcomes and reducing demand on healthcare services.40,41
COPD Quality standards call for early and accurate diagnosis through education, follow-up care and access to treatment following hospital discharge from an exacerbation.45 Growing evidence suggests that COPD hospital discharge bundles, comprising evidence-based best practices, are important to improve patient outcomes, address high COPD readmission rates and ensure continuity of care following an exacerbation.46 As most COPD is managed in primary care, it also has a significant role in implementing these standards, as well as ensuring timely diagnosis and referral to specialists, when needed.47,48 Additionally, calls from across the respiratory community emphasize that COPD should be addressed and treated with a similar sense of urgency as other chronic illnesses (for example, following a heart attack or stroke).
This urgent need is why we are calling on policymakers to make health system policy revisions to improve the quality and consistency of COPD care worldwide, for every person with COPD, regardless of socioeconomic status or geographical location.
Decarbonising respiratory care
Estimates suggest the climate crisis is likely to cause 250,000 additional deaths per year globally between 2030 and 2050.49 Poor air quality and extreme weather conditions pose great risks to those already living with respiratory disease,49,50 all of which will increase demand on already stretched healthcare systems, which subsequently have a greater impact on the environment.49
To achieve sustainable healthcare, we are working in collaboration with the respiratory community to drive action towards net zero, resilient, and equitable health systems.
Every interaction a patient has with their health system carries a carbon footprint. As health systems aim to provide the best care for patients, they also generate greenhouse gases, contributing to the burden of respiratory diseases.3,6,51 For example, COPD is the leading cause of hospitalisations in many countries. Missed opportunities for optimal disease management leads to negative disease progression, greater HCRU and an increased carbon footprint.3,6
Our work to move towards earlier intervention to improve outcomes for patients and decarbonise the footprint of care is coupled with our commitment to reduce the carbon footprint of our medicines. To achieve this, we are accelerating the transition of our inhaled respiratory medicines to an innovative propellant with near-zero global warming potential – 99.9% lower than in today’s medicines. We anticipate first transition to these propellants from 2025 onwards, subject to regulatory approvals.52
We are also implementing a CO2 optimisation framework to allow clinical teams to critically reflect on their proposed study design and encourage them to consider the balance between aspects that are critical for study integrity and those providing important insights.
Powerful ways to help patients and the planet
We cannot reinforce enough the strong interconnection between healthy people and a healthy planet. Earlier intervention and disease control to prevent exacerbations and hospitalisations are some of the most powerful ways to improve outcomes for patients and reduce overall HCRU, and thus also the carbon footprint of care.6,21-25,43,45
We are working to deliver transformative change across the patient journey, disease continuum and driving for earlier intervention. But we are not stopping there; we have already delivered inhaled therapies and biologics to treat the broad spectrum of asthma. As respiratory care evolves, we are looking into the future, and exploring underlying biologic drivers and the potential of pre-biologics and new modalities, ensuring there are viable solutions at every stage of respiratory diseases.
Together with the respiratory community we will not stop until we see all patients receiving prompt earlier intervention to improve their lives, and reduce the impact on healthcare systems, society and the planet. Together we will transform respiratory care.
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References
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Veeva ID: Z4-67481
Date of preparation: August 2024