<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0871-9721</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Imunoalergologia]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Imunoalergologia]]></abbrev-journal-title>
<issn>0871-9721</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Alergologia e Imunologia Clínica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0871-97212025000400219</article-id>
<article-id pub-id-type="doi">10.32932/rpia.2025.06.167</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Impacto ambiental da terapêutica inalada no tratamento da asma]]></article-title>
<article-title xml:lang="en"><![CDATA[The environmental impact of inhaled therapy in asthma treatment]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bragança*]]></surname>
<given-names><![CDATA[Mariana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pinhal*]]></surname>
<given-names><![CDATA[Ana Luísa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Areia*]]></surname>
<given-names><![CDATA[Margarida]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva*]]></surname>
<given-names><![CDATA[Duarte Nuno]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vasconcelos]]></surname>
<given-names><![CDATA[Maria João]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pereira]]></surname>
<given-names><![CDATA[Ana Margarida]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Paciência]]></surname>
<given-names><![CDATA[Inês]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Unidade Local de Saúde de São João Serviço de Imunoalergologia ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Unidade Local de Saúde de Gaia e Espinho Serviço de Imunoalergologia ]]></institution>
<addr-line><![CDATA[Vila Nova de Gaia ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Unidade Local de Saúde de Santo António Serviço de Imunoalergologia ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Lusíadas Saúde Hospital Lusíadas Porto Unidade de Imunoalergologia]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,CUF-Porto Hospital e Instituto Unidade de Imunoalergologia ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,University of Oulu Research Unit of Population Health Center for Environmental and Respiratory Health Research (CERH)]]></institution>
<addr-line><![CDATA[Oulu ]]></addr-line>
<country>Finlândia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>33</volume>
<numero>4</numero>
<fpage>219</fpage>
<lpage>232</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0871-97212025000400219&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0871-97212025000400219&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0871-97212025000400219&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[RESUMO O setor da saúde é responsável por 4,4% das emissões de gases com efeito de estufa a nível mundial, sendo a cadeia de abastecimento de produtos farmacêuticos e dispositivos médicos a sua principal fonte. No tratamento da asma, os inaladores têm um impacto ambiental significativo, especialmente os inaladores pressurizados de dose calibrada (pMDI), devido ao uso de gases propelentes. Alternativas como inaladores de pó seco (DPI) ou dispositivos de névoa suave apresentam menor potencial de aquecimento global, mas a escolha do dispositivo deve ser primariamente adequada à clínica e ao doente. A otimização do diagnóstico, abordagem de fatores de agravamento e instituição de terapêutica adequada são algumas estratégias fundamentais para reduzir o impacto ambiental. Neste artigo é feita uma revisão da evidência científica sobre o impacto ambiental dos inaladores no tratamento da asma que serve de base à identificação de estratégias práticas, passíveis de implementação no dia-a-dia, visando reduzir a pegada de carbono.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT The healthcare sector is responsible for about 4.4% of global greenhouse gas emissions. The healthcare supply chain is the main source of emissions. Due to propellant gases, asthma inhalers, particularly pressurized metered dose inhalers (pMDI), have a significant environmental impact. Dry powder inhalers (DPIs) or soft mist devices have a substantially lower global warming potential compared to pMDI, but the selection of a device should first be driven by clinical appropriateness. Improving the accuracy of asthma diagnosis and management are key factors to reduce the environmental impact of asthma treatment. This article reviews the scientific evidence on the environmental impact of inhalers in asthma treatment and identifies a set of practical strategies that can be implemented in daily practice to reduce the carbon footprint of inhaler therapy.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Asma]]></kwd>
<kwd lng="pt"><![CDATA[pegada de carbono]]></kwd>
<kwd lng="pt"><![CDATA[alterações climáticas]]></kwd>
<kwd lng="pt"><![CDATA[ambiente]]></kwd>
<kwd lng="pt"><![CDATA[gases com efeito de estufa]]></kwd>
<kwd lng="pt"><![CDATA[terapêutica]]></kwd>
<kwd lng="en"><![CDATA[Asthma]]></kwd>
<kwd lng="en"><![CDATA[carbon footprint]]></kwd>
<kwd lng="en"><![CDATA[climate change]]></kwd>
<kwd lng="en"><![CDATA[environment]]></kwd>
<kwd lng="en"><![CDATA[greenhouse gases]]></kwd>
<kwd lng="en"><![CDATA[therapeutics]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Karliner]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Slotterback]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Boyd]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ashby]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Steele]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Health care&#8217;s climate footprint: the health sector contribution and opportunities for action]]></article-title>
<source><![CDATA[Eur J Public Health]]></source>
<year>2020</year>
<volume>30</volume>
<numero>^s5</numero>
<issue>^s5</issue>
<supplement>5</supplement>
<page-range>165.843</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="">
<source><![CDATA[]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Health Care Without Harm in collaboration with Arup]]></article-title>
<source><![CDATA[Health care&#8217;s climate footprint report]]></source>
<year>2019</year>
<page-range>48</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rodríguez-Jiménez]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Romero-Martín]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Spruell]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Steley]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez-Salgado]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The carbon footprint of healthcare settings: A systematic review]]></article-title>
<source><![CDATA[J Adv Nurs]]></source>
<year>2023</year>
<volume>79</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>2830-44</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wu]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The carbon footprint of the Chinese health-care system: An environmentally extended input-output and structural path analysis study]]></article-title>
<source><![CDATA[Lancet Planet Health]]></source>
<year>2019</year>
<volume>3</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>e413-9</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lim]]></surname>
<given-names><![CDATA[AEK]]></given-names>
</name>
<name>
<surname><![CDATA[Perkins]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Agar]]></surname>
<given-names><![CDATA[JWM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The carbon footprint of an Australian satellite haemodialysis unit]]></article-title>
<source><![CDATA[Aust Health Rev]]></source>
<year>2013</year>
<volume>37</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>369</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Désy]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Lachapelle]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Couillard]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The excessive carbon footprint of inhalers used in airway disease and its remedies]]></article-title>
<source><![CDATA[TouchREVIEWS Respir Pulm Dis]]></source>
<year>2023</year>
<volume>8</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>1</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Woodcock]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Beeh]]></surname>
<given-names><![CDATA[KM]]></given-names>
</name>
<name>
<surname><![CDATA[Sagara]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Aumônier]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Addo-Yobo]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Khan]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The environmental impact of inhaled therapy: making informed treatment choices]]></article-title>
<source><![CDATA[Eur Respir J]]></source>
<year>2022</year>
<volume>60</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pernigotti]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Stonham]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Panigone]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Sandri]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Ferri]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Unal]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reducing carbon footprint of inhalers: analysis of climate and clinical implications of different scenarios in five European countries]]></article-title>
<source><![CDATA[BMJ Open Respir Res]]></source>
<year>2021</year>
<volume>8</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Woodcock]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Janson]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Rees]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Frith]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Löfdahl]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Moore]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effects of switching from a metered dose inhaler to a dry poder inhaler on climate emissions and asthma control: post-hoc analysis]]></article-title>
<source><![CDATA[Thorax]]></source>
<year>2022</year>
<volume>77</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>1187-92</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gupta]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Couillard]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Digby]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Tse]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Green]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Penz]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Climate change and inhaler selection in patients with respiratory disease]]></article-title>
<source><![CDATA[Chest]]></source>
<year>2024</year>
<volume>165</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>503-6</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bickhardt]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Czupalla]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Bader]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reduktion klimaschädlicher Treibhausgase durch Auswahl der Inhalatoren in der Therapie von Patienten mit Asthma und COPD]]></article-title>
<source><![CDATA[Pneumologie]]></source>
<year>2022</year>
<volume>76</volume>
<numero>05</numero>
<issue>05</issue>
<page-range>321&#8209;9</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Alzaabi]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bell]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Montero-Arias]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Price]]></surname>
<given-names><![CDATA[DB]]></given-names>
</name>
<name>
<surname><![CDATA[Jackson]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[HC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Greenhouse gas emissions from respiratory treatments: Results from the SABA CARBON international study]]></article-title>
<source><![CDATA[Adv Ther]]></source>
<year>2023</year>
<volume>40</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>4836-56</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Global strategy for asthma management and prevention, 2023]]></article-title>
<source><![CDATA[Global Initiative for Asthma]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Song]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Adeloye]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Salim]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Dos Santos]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Campbell]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Sheikh]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Global, regional, and national prevalence of asthma in 2019: A systematic analysis and modelling study]]></article-title>
<source><![CDATA[J Glob Health]]></source>
<year>2022</year>
<volume>12</volume>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Brito]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Jácome]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Bulhões]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Barbosa]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Pina]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Alves Da Silva]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of asthma in Portuguese adults - the EPI-ASTHMA study, a nationwide population-based survey]]></article-title>
<source><![CDATA[Pulmonology]]></source>
<year>2025</year>
<volume>31</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Panigone]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Sandri]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Ferri]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Volpato]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Nudo]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Nicolini]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Environmental impact of inhalers for respiratory diseases: decreasing the carbon footprint while preserving patient-tailored treatment]]></article-title>
<source><![CDATA[BMJ Open Respir Res]]></source>
<year>2020</year>
<volume>7</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dalby]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Eicher]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Zierenberg]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Respimat(®) Soft MistTM Inhaler and its clinical utility in respiratory disorders]]></article-title>
<source><![CDATA[Med Devices Evid Res]]></source>
<year>2011</year>
<volume>145</volume>
</nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Janson]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Henderson]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Löfdahl]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Hedberg]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Sharma]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Wilkinson]]></surname>
<given-names><![CDATA[AJK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Carbon footprint impact of the choice of inhalers for asthma and COPD]]></article-title>
<source><![CDATA[Thorax]]></source>
<year>2020</year>
<volume>75</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>82-4</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wilkinson]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Woodcock]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The environmental impact of inhalers for asthma: A green challenge and a golden opportunity]]></article-title>
<source><![CDATA[Br J Clin Pharmacol]]></source>
<year>2022</year>
<volume>88</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>3016-22</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Global Warming Potential Values]]></article-title>
<source><![CDATA[Greenhouse Gas Protocol]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Comparison Between CHF5993 pMDI 200/ 6/ 12,5mg HFA-152a VS CHF5993 pMDI 200/ 6/ 12,5mg HFA-134a in Subjects With Asthma (TRECOS)]]></article-title>
<source><![CDATA[Chiesi Farmaceutici S.p.A]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tirumalasetty]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Miller]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Prescott]]></surname>
<given-names><![CDATA[HC]]></given-names>
</name>
<name>
<surname><![CDATA[DeTata]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Arroyo]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
<name>
<surname><![CDATA[Wilkinson]]></surname>
<given-names><![CDATA[AJK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Greenhouse Gas Emissions and Costs of In-haler Devices in the US]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2024</year>
<volume>332</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>1017</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Campos]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Rosa]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Carreiro Martins]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Xavier]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Leuschner]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[MI]]></surname>
<given-names><![CDATA[M. Marques]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Recomendações para a redução do impacto ambiental dos inaladores em Portugal: Documento de Consenso]]></article-title>
<source><![CDATA[Acta Médica Port]]></source>
<year>2024</year>
<volume>37</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>654-61</page-range></nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Montgomery]]></surname>
<given-names><![CDATA[BD]]></given-names>
</name>
<name>
<surname><![CDATA[Blakey]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Respiratory inhalers and the environment]]></article-title>
<source><![CDATA[Aust J Gen Pract]]></source>
<year>2022</year>
<volume>51</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>929-34</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Montoro]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Antolín-Amérigo]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Izquierdo-Domínguez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Zapata]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Valero]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Impact of asthma inhalers on global climate: A systematic review of their carbon footprint and clinical outcomes in Spain]]></article-title>
<source><![CDATA[J Investig Allergy Clin Immunol]]></source>
<year>2023</year>
<volume>33</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>250-62</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jeswani]]></surname>
<given-names><![CDATA[HK]]></given-names>
</name>
<name>
<surname><![CDATA[Azapagic]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Life cycle environmental impacts of inhalers]]></article-title>
<source><![CDATA[J Clean Prod]]></source>
<year>2019</year>
<volume>237</volume>
</nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Janson]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Maslova]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Wilkinson]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Penz]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Papi]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Budgen]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The carbon footprint of respiratory treatments in Europe and Canada: an observational study from the CARBON programme]]></article-title>
<source><![CDATA[Eur Respir J]]></source>
<year>2022</year>
<volume>60</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gagné]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Karanikas]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Green]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Gupta]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis]]></article-title>
<source><![CDATA[BMJ Open Respir Res]]></source>
<year>2023</year>
<volume>10</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wilkinson]]></surname>
<given-names><![CDATA[AJK]]></given-names>
</name>
<name>
<surname><![CDATA[Maslova]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Janson]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Radhakrishnan]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Quint]]></surname>
<given-names><![CDATA[JK]]></given-names>
</name>
<name>
<surname><![CDATA[Budgen]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe-Based envirONmental cost of treatment (CARBON) study]]></article-title>
<source><![CDATA[Thorax]]></source>
<year>2024</year>
<volume>79</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>412-21</page-range></nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hatter]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Holliday]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Eathorne]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bruce]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Pavord]]></surname>
<given-names><![CDATA[ID]]></given-names>
</name>
<name>
<surname><![CDATA[Reddel]]></surname>
<given-names><![CDATA[HK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The carbon footprint of as-needed budesonide/formoterol in mild asthma: a post hoc analysis]]></article-title>
<source><![CDATA[Eur Respir J]]></source>
<year>2024</year>
<volume>64</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Sobre One Health]]></article-title>
<source><![CDATA[Instituto de Ciências Biomédicas Abel Salazar (ICBAS]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[EAACI GoGreen webinar: How to go green via Inhalers]]></article-title>
<source><![CDATA[EAACI Knowledge Hub]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Usmani]]></surname>
<given-names><![CDATA[OS]]></given-names>
</name>
<name>
<surname><![CDATA[Levy]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effective respiratory management of asthma and COPD and the environmental impacts of inhalers]]></article-title>
<source><![CDATA[Npj Prim Care Respir Med]]></source>
<year>2023</year>
<volume>33</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>24</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="">
<article-title xml:lang=""><![CDATA[Asthma article 2: Disposing of asthma inhalers to reduce their environmental impact]]></article-title>
<source><![CDATA[]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B36">
<label>36</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Huffman]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Hough]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A Hidden Contributor to Climate Change - Asthma Inhalers]]></article-title>
<source><![CDATA[]]></source>
<year>2023</year>
</nlm-citation>
</ref>
<ref id="B37">
<label>37</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Murphy]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Howlett]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Gowson]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Lewis]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Understanding the feasibility and environmental effectiveness of a pilot postal inhaler recovery and recycling scheme]]></article-title>
<source><![CDATA[Npj Prim Care Respir Med]]></source>
<year>2023</year>
<volume>33</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>5</page-range></nlm-citation>
</ref>
<ref id="B38">
<label>38</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Complete the Cycle: Breathe new life into your inhalers]]></article-title>
<source><![CDATA[GlaxoSmithKline]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B39">
<label>39</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Clews]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Inhaler recycling scheme that cut carbon emissions equivalente to more than 8500 cars is scrapped]]></article-title>
<source><![CDATA[Pharm J]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B40">
<label>40</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Green scheme helps to breathe new life into used inhalers]]></article-title>
<source><![CDATA[Swansea Bay Health News]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B41">
<label>41</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[UK-wide inhaler recycling scheme launched in push to reduce NHS emissions]]></article-title>
<source><![CDATA[Hospital Times]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B42">
<label>42</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[INSPIRE - Inhaler Return and recycling scheme]]></article-title>
<source><![CDATA[AstraZeneca UK Ltd, Royal Wolverhampton NHS]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B43">
<label>43</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Engaging Primary Care for the health of people and planet]]></article-title>
<source><![CDATA[Greener Practice]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B44">
<label>44</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Green Inhaler: Making your inhaler more environmentally friendly]]></article-title>
<source><![CDATA[Green Inhaler]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B45">
<label>45</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Lowering the inhaler carbon footprint]]></article-title>
<source><![CDATA[Respiratory care]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B46">
<label>46</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Figueiredo]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[VALORMED - Relatório de Actividades 2023 - Resumo]]></article-title>
<source><![CDATA[]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B47">
<label>47</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Janson]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Hernando Platz]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Soulard]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Langham]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Nicholson]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Hartgers-Gubbels]]></surname>
<given-names><![CDATA[ES]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reducing carbon footprint by switching to reusable soft-mist inhalers]]></article-title>
<source><![CDATA[ERJ Open Res]]></source>
<year>2023</year>
<volume>9</volume>
<page-range>00543-2022</page-range></nlm-citation>
</ref>
<ref id="B48">
<label>48</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De Simón Gutiérrez]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ginel Mendoza]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Hidalgo Requena]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rico Munilla]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Cantalapiedra Fernández]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Desechan correctamente los pacientes sus dispositivos de inhalación? Proyecto AIRE]]></article-title>
<source><![CDATA[Semergen]]></source>
<year>2022</year>
<volume>48</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>14-22</page-range></nlm-citation>
</ref>
<ref id="B49">
<label>49</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Inget]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Hisinger-Mölkänen]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Howard]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Lähelmä]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Paronen]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cradle-to-Grave Emission Reduction for Easyhaler Dry Powder Inhaler Product Portfolio]]></article-title>
<source><![CDATA[Pulm Ther]]></source>
<year>2023</year>
<volume>9</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>527-33</page-range></nlm-citation>
</ref>
<ref id="B50">
<label>50</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Law]]></surname>
<given-names><![CDATA[AV]]></given-names>
</name>
<name>
<surname><![CDATA[Sakharkar]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Zargarzadeh]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Tai]]></surname>
<given-names><![CDATA[BWB]]></given-names>
</name>
<name>
<surname><![CDATA[Hess]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Hata]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Taking stock of medication wastage: Unused medications in US households]]></article-title>
<source><![CDATA[Res Soc Adm Pharm]]></source>
<year>2015</year>
<volume>11</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>571-8</page-range></nlm-citation>
</ref>
<ref id="B51">
<label>51</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Veiga]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Sousa]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
<name>
<surname><![CDATA[Sousa]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Oliveira]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Neto]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[End-of-life management strategies of pharmaceuticals in Portuguese households]]></article-title>
<source><![CDATA[Waste Manag Res J Sustain Circ Econ]]></source>
<year>2023</year>
<volume>41</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>235-47</page-range></nlm-citation>
</ref>
<ref id="B52">
<label>52</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hiew]]></surname>
<given-names><![CDATA[SY]]></given-names>
</name>
<name>
<surname><![CDATA[Low]]></surname>
<given-names><![CDATA[BY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A systematic review of the knowledge, attitude and practice of healthcare professionals and healthcare professional students towards household pharmaceutical waste disposal]]></article-title>
<source><![CDATA[Explor Res Clin Soc Pharm]]></source>
<year>2025</year>
<volume>17</volume>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
