Asthma ManagementNCT07638735
eAMS-Eco: Implementation of a Tool for Climate Conscious Inhaler Prescribing
A study testing Climate-Conscious Clinical Decision Support System for Asthma Management in people with Asthma Management and Asthma, run by University of Toronto at 2 sites in Canada.
Trial summary
The goal of this study is to determine whether an 'eco' version of the Electronic Asthma Management System (eAMS) can reduce inhaler carbon emissions in primary care, in patients with asthma. Read more about this study
- Who is it for?
- Ages 16 years and older
- Conditions the study is for
- Asthma Management, Asthma, Computerized Decision Support System
- What is being tested?
- Climate-Conscious Clinical Decision Support System for Asthma Management
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 95 participants
- Where
- 2 sitesCanada
- Study dates
- 28 Apr 2026to 7 Jul 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 16 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- -Active clinician at one of the two study sites during the study period
- Patient eligibility criteria:
- Patient at one of the two study sites with a visit during the study period
- Diagnosis of asthma (using validated algorithm for primary care of
- asthma billing code (493) in the past 3 years OR asthma in the cumulative patient profile (CPP) and
- prescription for an inhaler in the past year
Who cannot join
None listed.
Trial locations and contacts
2 sites in 1 country. Contact the study team or a site near you to ask about taking part.
Canada2 sites
Taddle Creek Family Health Team (Bay Street)
Toronto, Ontario, M5G 1N8
Taddle Creek Family Health Team (Bloor Street)
Toronto, Ontario, M6G 4A1
About this study
Official title: eAMS-Eco: Implementation of a Climate Conscious Prescribing Aid at the Point-of-Care
The goal of this study is to determine whether an 'eco' version of the Electronic Asthma Management System (eAMS) can reduce inhaler carbon emissions in primary care, in patients with asthma. The existing eAMS uses patient-specific criteria (asthma control, asthma flare-up risk, and current medications) to provide guideline-based computerized clinical decision support to clinicians, to improve the delivery of asthma care. The eAMS-Eco includes embedded cues and messaging on the environmental impact of inhaler medications and links to a patient-friendly conversation aid that facilitates shared decision-making and climate-conscious prescribing.
The study will evaluate the implementation of the eAMS-Eco in two primary care clinics that have been using the existing eAMS, using an interrupted time-series analysis (one year pre- and post-launch of the eAMS-Eco). The investigators will assess system uptake and user feedback on the eAMS-Eco, as well as changes in inhaler prescriptions (including resulting changes in carbon emissions and costs) and changes in asthma control, in the implementation period (eAMS-Eco) compared to the baseline period (eAMS).
Read the detailed description
Climate change poses a significant threat to human health and yet healthcare itself contributes substantially to climate change. Reducing the carbon emissions from healthcare is one actionable step to combat the climate crisis. In regards to asthma care, reductions in carbon emissions could be achieved by addressing the unnecessary of metered-dose inhalers (MDIs), the propellants in which contain potent greenhouse gases. This could be achieved by preferentially prescribing inhaler devices such as dry powder inhalers (DPIs) and soft mist inhalers (SMIs), which do not use propellants and have much lower carbon footprints than MDIs. These devices are almost always available in the same medication classes as MDIs (sometimes with the same active ingredient) and demonstrate comparable clinical efficacy and patient acceptability. Yet MDIs still account for the majority of prescribed inhalers.
The investigators will leverage the existing Electronic Asthma Management System (eAMS), a computerized decision support system (CDSS) that recommends guideline-based medication changes based on assessment of the patients' asthma control and exacerbation risk, to promote climate-conscious prescribing at the point-of-care. When tested in real-world settings, the eAMS improved the quality of asthma care, with a significant increase in the provision of asthma action plans, assessment of asthma control, use of guideline-based inhaler medications, including escalation of controller therapy when indicated. Subsequently, the tool has been used widely in primary care sites in Ontario. To address the issue of inhaler GHG emissions, our team has now created an enhanced version of the existing eAMS, called the 'eAMS-Eco'.
The eAMS-Eco has embedded cues and messaging that indicate the relative carbon footprint of each medication recommended by the eAMS, to provide clinicians with the knowledge needed to enact climate-conscious prescribing. A an orange or red leaf appears next to the recommended medication with hover text indicating that the device has a moderate or high carbon footprint, respectively. The medication name and hover text are clickable links which take the clinician to an inhaler conversation aid, which serves to promote shared decision-making by presenting the carbon footprint (as the equivalent to kilometers driven in a gas powered car) and cost of each inhaler in the corresponding medication class, along with usage details (dosing, number of inhalations per dose, number of doses per device). The conversation aids also include information on inhaler contents (active ingredients) and include a safety warning that emphasizes the importance of considering patient-level factors, such as adequate technique, age, disease severity, and the impact on adherence, when selecting an inhaler device.
Ultimately, the eco-features added to the eAMS are designed to promote climate-conscious prescribing of inhalers while considering the preference and ability of each individual patient. Our study will evaluate the implementation of the eAMS-Eco in two primary care clinics which are already using the eAMS, with an overall goal of reducing inhaler emissions in the primary care of patients with asthma.
- Being tested
- Climate-Conscious Clinical Decision Support System for Asthma Management
- Keywords
- Electronic Asthma Management System (eAMS), Computerized Decision Support System (CDSS), Asthma, Asthma Management
- Medical subject headings
- Asthma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Climate-Conscious Clinical Decision Support System for Asthma ManagementBehavioural
Also called eAMS-Eco
An 'eco' version of a computerized clinical decision support system that provides information on the carbon footprint of inhalers when making guideline-based treatment recommendations for patients with asthma
| Study group | Role | What they receive |
|---|---|---|
| Electronic Asthma Management System (eAMS) | No intervention | A retrospective chart review and system audit will assess outcomes during the one-year baseline period where the base version of the Electronic Asthma Management System (eAMS) was in use |
| eAMS-Eco | Active comparator | The eAMS-Eco will be launched at study sites and available to clinicians to use for eligible patients with data collected prospectively for 12 months Receives: Behavioral: Climate-Conscious Clinical Decision Support System for Asthma Management |
What is being measured
The primary outcome is the main question the study is designed to answer.
Prescribed inhaler carbon emissions
Among patients entering on at least one metered dose inhaler, system analytics, chart review and existing data on inhaler carbon emissions will be used to assess the average and total difference in the change (exit versus entry medications) in estimated annual carbon emissions from inhalers per patient between the baseline and implementation periods
Measured: 24 months, cumulative and broken into individual time periods
Proportion of low carbon footprint inhalers to moderate/high carbon footprint inhalers prescribed
For all new inhaler prescriptions, system analytics and chart review data will be used to compare the difference in the average proportion of low to moderate/high carbon footprint inhalers across all patients, between the baseline and implementation periods
Measured: 24 months, cumulative and broken into individual time periods
Secondary outcomes (10)
Cost of prescribed inhalers
Among patients entering on at least one metered dose inhaler, system analytics, chart review and data from Ontario's provincial drug formulary will be used to assess the difference in the change (exit versus entry medications) in the estimated annual cost of prescribed inhalers, per patient, between the baseline and implementation periods
Measured: 24 months, cumulative and broken into individual time periods
System usage: conversation aid access
Using system analytics from the implementation period, investigators will determine the proportion of visits in which the conversation aid was accessed when it was available and assess trends in access over time
Measured: 12 months, cumulative and broken into individual time periods
System usage: decision-support access
Using system analytics, investigators will assess compare use of the decision support (access, medication changes, and asthma action plans created) between the baseline and implementation period
Measured: 24 months, cumulative and broken into individual time periods
Quantitative patient Likert-Scale questionnaire
Exclusively throughout the implementation period, the investigators will identify clinic visits where the conversation aid was available and invite patients to complete an online feedback questionnaire to assess perceptions on the conversation aid's utility, content, and impact (using a 5-point likert scale from strongly disagree to strongly agree), overall impressions (rating from 1: worst to 10: best) and impact of switching (or not switching) to a lower carbon device on inhaler adherence, feelings of guilt, and contribution to climate action.
Measured: 12 months
Patient feedback: 4-item Shared Decision-Making Process Scale
Exclusively throughout the implementation period, the investigators will identify clinic visits where the conversation aid was available and invite patients to complete the 4-item Shared Decision-Making (SDM) Process Scale (Version 2.0) which measures the amount of SDM that occurs around inhaler selection to assess the quality of shared decision-making during their recent clinic visit. Higher scores (range 0 to 4) reflect higher quality of SDM.
Measured: 12 months
Qualitative patient free-text feedback questionnaire
Exclusively throughout the implementation period, the investigators will identify clinic visits in which the conversation aid was available and invite patients to provide feedback on their experience during their recent clinic visit
Measured: 12 months
Quantitative provider Likert-Scale questionnaire
At the end of the implementation period, all providers who accessed the eAMS-Eco and had at least one visit with the Eco features triggered, will be invited to complete an online questionnaire to assess their perceptions of the eAMS-Eco and the conversation aid's utility, content and impact (using a 5-point likert scale from strongly disagree to strongly agree).
Measured: 12 months
Provider feedback: 10-item System Usability Scale
At the end of the implementation period, all providers who accessed the eAMS-Eco and had at least one visit with the Eco features triggered, will be invited to complete the 10-item System Usability Scale (SUS) to assess feedback on system usability (using a 5-point likert scale from strongly disagree to strongly agree). Higher scores (range 0 to 100) reflect higher overall usability.
Measured: 12 months
Qualitative provider free-text feedback questionnaire
At the end of the implementation period, all providers who accessed the eAMS-Eco and had at least one visit with the Eco features triggered, will be invited to provide feedback on their experience using the eAMS-Eco
Measured: 12 months
Asthma Control
Among all patients who had at least one visit during the baseline and/or implementation period, the investigators will assess change in asthma control, exclusively using data from the pre-visit eAMS questionnaire (among patients with multiple visits during the baseline and/or implementation period) or by inviting patients to complete the pre-visit questionnaire at the end of the baseline and/or implementation period (among patients with a single visit during either period). Asthma control is scored as acceptable or suboptimal according to Canadian guidelines based on frequency of daytime symptoms, rescue medication use; nighttime awakenings; impact on school/work attendance; impact on exercise; and exacerbations.
Measured: 24 months, cumulative and broken into individual time periods
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Jun 2026
- Study start28 Apr 2026
- Primary completion28 Apr 2027 (estimated)
- Study completion7 Jul 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Asthma ManagementStudies of the same condition, open and under way.
- More trials run by University of TorontoThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Model description
- Interrupted Time Series Analysis
- Masking
- None (open label)
- Enrolment
- 95 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Toronto
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Samir Gupta, University of Toronto
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07638735
- Sponsor's protocol ID
- 25-271
- Status last verified
- Jun 2026
- First submitted
- 27 May 2026
- Last updated
- 7 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 7 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- eAMS-Eco: Implementation of a Climate Conscious Prescribing Aid at the Point-of-Care
- ClinicalTrials.gov ID
- NCT07638735
- Acronym / sponsor ID
- 25-271
- Keywords
- Electronic Asthma Management System (eAMS), Computerized Decision Support System (CDSS), Asthma, Asthma Management
- Study type
- Interventional
- Recruitment status
- Enrolling by invitation
- Enrolment
- 95 participants (estimated)
- Lead sponsor
- University of TorontoUniversity, hospital or other
- Study start
- 28 Apr 2026 (actual)
- Primary completion
- 28 Apr 2027 (estimated)
- Study completion
- 7 Jul 2027 (estimated)
- First posted
- 10 Jun 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this study is to determine whether an 'eco' version of the Electronic Asthma Management System (eAMS) can reduce inhaler carbon emissions in primary care, in patients with asthma. The existing eAMS uses patient-specific criteria (asthma control, asthma flare-up risk, and current medications) to provide guideline-based computerized clinical decision support to clinicians, to improve the delivery of asthma care. The eAMS-Eco includes embedded cues and messaging on the environmental impact of inhaler medications and links to a patient-friendly conversation aid that facilitates shared decision-making and climate-conscious prescribing.
The study will evaluate the implementation of the eAMS-Eco in two primary care clinics that have been using the existing eAMS, using an interrupted time-series analysis (one year pre- and post-launch of the eAMS-Eco). The investigators will assess system uptake and user feedback on the eAMS-Eco, as well as changes in inhaler prescriptions (including resulting changes in carbon emissions and costs) and changes in asthma control, in the implementation period (eAMS-Eco) compared to the baseline period (eAMS).
Detailed description
Climate change poses a significant threat to human health and yet healthcare itself contributes substantially to climate change. Reducing the carbon emissions from healthcare is one actionable step to combat the climate crisis. In regards to asthma care, reductions in carbon emissions could be achieved by addressing the unnecessary of metered-dose inhalers (MDIs), the propellants in which contain potent greenhouse gases. This could be achieved by preferentially prescribing inhaler devices such as dry powder inhalers (DPIs) and soft mist inhalers (SMIs), which do not use propellants and have much lower carbon footprints than MDIs. These devices are almost always available in the same medication classes as MDIs (sometimes with the same active ingredient) and demonstrate comparable clinical efficacy and patient acceptability. Yet MDIs still account for the majority of prescribed inhalers.
The investigators will leverage the existing Electronic Asthma Management System (eAMS), a computerized decision support system (CDSS) that recommends guideline-based medication changes based on assessment of the patients' asthma control and exacerbation risk, to promote climate-conscious prescribing at the point-of-care. When tested in real-world settings, the eAMS improved the quality of asthma care, with a significant increase in the provision of asthma action plans, assessment of asthma control, use of guideline-based inhaler medications, including escalation of controller therapy when indicated. Subsequently, the tool has been used widely in primary care sites in Ontario. To address the issue of inhaler GHG emissions, our team has now created an enhanced version of the existing eAMS, called the 'eAMS-Eco'.
The eAMS-Eco has embedded cues and messaging that indicate the relative carbon footprint of each medication recommended by the eAMS, to provide clinicians with the knowledge needed to enact climate-conscious prescribing. A an orange or red leaf appears next to the recommended medication with hover text indicating that the device has a moderate or high carbon footprint, respectively. The medication name and hover text are clickable links which take the clinician to an inhaler conversation aid, which serves to promote shared decision-making by presenting the carbon footprint (as the equivalent to kilometers driven in a gas powered car) and cost of each inhaler in the corresponding medication class, along with usage details (dosing, number of inhalations per dose, number of doses per device). The conversation aids also include information on inhaler contents (active ingredients) and include a safety warning that emphasizes the importance of considering patient-level factors, such as adequate technique, age, disease severity, and the impact on adherence, when selecting an inhaler device.
Ultimately, the eco-features added to the eAMS are designed to promote climate-conscious prescribing of inhalers while considering the preference and ability of each individual patient. Our study will evaluate the implementation of the eAMS-Eco in two primary care clinics which are already using the eAMS, with an overall goal of reducing inhaler emissions in the primary care of patients with asthma.
Study design
- Primary purpose
- Health services research
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Interrupted Time Series Analysis
| Arm | Type | Receives |
|---|---|---|
| Electronic Asthma Management System (eAMS) | No intervention | –A retrospective chart review and system audit will assess outcomes during the one-year baseline period where the base version of the Electronic Asthma Management System (eAMS) was in use |
| eAMS-Eco | Active comparator | Behavioral: Climate-Conscious Clinical Decision Support System for Asthma ManagementThe eAMS-Eco will be launched at study sites and available to clinicians to use for eligible patients with data collected prospectively for 12 months |
Who may qualify
- Ages
- 16 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (6 listed)
- -Active clinician at one of the two study sites during the study period
- Patient at one of the two study sites with a visit during the study period
- Diagnosis of asthma (using validated algorithm for primary care of
Key exclusion criteria (0 listed)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Climate-Conscious Clinical Decision Support System for Asthma ManagementAlso: eAMS-EcoAn 'eco' version of a computerized clinical decision support system that provides information on the carbon footprint of inhalers when making guideline-based treatment recommendations for patients with asthma | Behavioural | eAMS-Eco |
Primary outcome
Prescribed inhaler carbon emissions
Time frame: 24 months, cumulative and broken into individual time periods
Among patients entering on at least one metered dose inhaler, system analytics, chart review and existing data on inhaler carbon emissions will be used to assess the average and total difference in the change (exit versus entry medications) in estimated annual carbon emissions from inhalers per patient between the baseline and implementation periods
Proportion of low carbon footprint inhalers to moderate/high carbon footprint inhalers prescribed
Time frame: 24 months, cumulative and broken into individual time periods
For all new inhaler prescriptions, system analytics and chart review data will be used to compare the difference in the average proportion of low to moderate/high carbon footprint inhalers across all patients, between the baseline and implementation periods
10 secondary outcomes
Cost of prescribed inhalers
Time frame: 24 months, cumulative and broken into individual time periods
System usage: conversation aid access
Time frame: 12 months, cumulative and broken into individual time periods
System usage: decision-support access
Time frame: 24 months, cumulative and broken into individual time periods
Quantitative patient Likert-Scale questionnaire
Time frame: 12 months
Patient feedback: 4-item Shared Decision-Making Process Scale
Time frame: 12 months
Qualitative patient free-text feedback questionnaire
Time frame: 12 months
Quantitative provider Likert-Scale questionnaire
Time frame: 12 months
Provider feedback: 10-item System Usability Scale
Time frame: 12 months
Qualitative provider free-text feedback questionnaire
Time frame: 12 months
Asthma Control
Time frame: 24 months, cumulative and broken into individual time periods
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Aug 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
The record lists no contact. Use the official record to reach the sponsor.
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Climate-Conscious Clinical Decision Support System for Asthma Management in people with Asthma Management and Asthma, run by University of Toronto at 2 sites in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: enrolling by invitation, as of the sponsor's last update on 7 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Prescribed inhaler carbon emissions (time frame: 24 months, cumulative and broken into individual time periods). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Aug 2026.