Management of Chronic Obstructive Pulmonary Disease in the Era of Environmental Sustainability: Can We Achieve Excellence?

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