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Peer-reviewedCC BY-NC 4.0Multidisciplinary Respiratory Medicine

Management of chronic obstructive pulmonary disease in the era of environmental sustainability: Can we achieve excellence?

  • Fabiano Di Marco1
  • Federico Lavorini2
  • Francesco Pistelli3
  • Fabio Arpinelli4
  • Claudio Micheletto5
  • Pierachille Santus6
  • Elisiana Carpagnano7
  • Angelo Guido Corsico8
  • Paola Rogliani9
  • Maria D’Amato10
  • Carmen Stabile4
  • Federica Piccolo11
1 more authors
  • Lorenzo Giovanni Mantovani12
12 affiliations
  1. 1Department of Health Sciences, University of Milan Respiratory Diseases ward, Papa Giovanni XXIII Hospital, Bergamo, Italy
  2. 2Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  3. 3Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
  4. 4Direzione Medica GSK, Verona, Italy
  5. 5Pneumologic Unit, Azienda Ospedaliera Universitaria Integrata 37126 Verona, Italy
  6. 6Department of Biomedical and Clinical Sciences, University of Milan and Division of Respiratory Diseases, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan
  7. 7Respiratory Diseases Section, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari, Bari, Italy
  8. 8Pneumology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy and Department of Internal Medicine, University of Pavia, Pavia, Italy
  9. 9Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
  10. 10Division of Pneumology, “V. Monaldi” University Hospital, Naples, Italy
  11. 11Access to Medicine, GSK, Verona, Italy
  12. 12Center for Public Health Research, University of Milan–Bicocca, Monza, Italy and Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Abstract

Background: The healthcare sector is a major contributor to greenhouse gas emissions, prompting an urgent need for environmentally sustainable practices. Chronic Obstructive Pulmonary Disease (COPD) management presents unique challenges in this context due to the frequent use of metered-dose inhalers containing high global warming potential propellants and the resource-intensive nature of acute exacerbations.

Methods: This expert consensus paper explores how COPD care can be optimized to reduce environmental impact, while maintaining high standards of clinical effectiveness. We examine the patient journey, adherence patterns, and therapeutic strategies, including the role of single-inhaler triple therapy in preventing exacerbation, as determinants of healthcare-related emissions.

Results: The potential of dry powder inhalers, accurate diagnosis, patient engagement, and sustained disease stability are highlighted as levers for environmentally sustainable care. We advocate for the integration of environmental impact as a formal outcome in randomized controlled trials, supported by standardized Life Cycle Assessment methodologies.

Conclusions: Our findings suggest that environmentally conscious COPD management is not only possible but may enhance clinical outcomes and system sustainability.

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Cite

BibTeXRIS
BibTeX
@article{marco2026management,
  title = {{Management of chronic obstructive pulmonary disease in the era of environmental sustainability: Can we achieve excellence?}},
  author = {Fabiano Di Marco and Federico Lavorini and Francesco Pistelli and Fabio Arpinelli and Claudio Micheletto and Pierachille Santus and Elisiana Carpagnano and Angelo Guido Corsico and Paola Rogliani and Maria D’Amato and Carmen Stabile and Federica Piccolo and Lorenzo Giovanni Mantovani},
  journal = {Multidisciplinary Respiratory Medicine},
  year = {2026},
  month = oct,
  doi = {10.5826/mrm.2026.1092},
  url = {https://doi.org/10.5826/mrm.2026.1092},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Management of chronic obstructive pulmonary disease in the era of environmental sustainability: Can we achieve excellence?
AU  - Fabiano Di Marco
AU  - Federico Lavorini
AU  - Francesco Pistelli
AU  - Fabio Arpinelli
AU  - Claudio Micheletto
AU  - Pierachille Santus
AU  - Elisiana Carpagnano
AU  - Angelo Guido Corsico
AU  - Paola Rogliani
AU  - Maria D’Amato
AU  - Carmen Stabile
AU  - Federica Piccolo
AU  - Lorenzo Giovanni Mantovani
PY  - 2026
DA  - 2026/10/28
JO  - Multidisciplinary Respiratory Medicine
DO  - 10.5826/mrm.2026.1092
UR  - https://doi.org/10.5826/mrm.2026.1092
AB  - Background: The healthcare sector is a major contributor to greenhouse gas emissions, prompting an urgent need for environmentally sustainable practices. Chronic Obstructive Pulmonary Disease (COPD) management presents unique challenges in this context due to the frequent use of metered-dose inhalers containing high global warming potential propellants and the resource-intensive nature of acute exacerbations.  Methods: This expert consensus paper explores how COPD care can be optimized to reduce environmental impact, while maintaining high standards of clinical effectiveness. We examine the patient journey, adherence patterns, and therapeutic strategies, including the role of single-inhaler triple therapy in preventing exacerbation, as determinants of healthcare-related emissions.  Results: The potential of dry powder inhalers, accurate diagnosis, patient engagement, and sustained disease stability are highlighted as levers for environmentally sustainable care. We advocate for the integration of environmental impact as a formal outcome in randomized controlled trials, supported by standardized Life Cycle Assessment methodologies.  Conclusions: Our findings suggest that environmentally conscious COPD management is not only possible but may enhance clinical outcomes and system sustainability.
SN  - 1828-695X
SN  - 2049-6958
ER  -