Greener Respiratory Care Across NHS Devon.
Why is this important
NHS Devon Integrated Care Board (ICB) is aiming to contribute towards national ambitions to reduce greenhouse gas emissions to net-zero by 2040. This is in alignment to the NHS Long Term Plan, and Greener NHS programme.
Pressurised metered dose inhalers (MDIs) prescribed within the National Health Service (NHS) contribute approximately 3% of all greenhouse gas emissions generated by the healthcare system. These inhalers contain hydrofluorocarbon (HFC) gases that are used as propellants to deliver medicine to a patients’ lungs; the propellants that are used are potent greenhouse gases with a global warming effect.
Salbutamol MDI, a short acting reliever inhaler, has been identified as the largest single source of carbon emissions from NHS medicines prescribing. In December 2023, a total of 50,795 salbutamol MDI inhalers prescribed across Devon, and an additional 66,164 non-salbutamol MDI inhalers were prescribed across Devon.
Greener Practice have produced a guide for healthcare professionals on How to Reduce the Carbon Footprint of Inhaler Prescribing. This has been reviewed and approved by the NHS England and NHS Inhaler Working Group, Asthma UK and the British Lung Foundation. It includes the principles on how to approach this work, a frequently asked questions section and a handy table on inhaler devices and their carbon footprint category.
Finally, the most environmentally friendly way to dispose of inhalers is to return them to a pharmacy for incineration which significantly degrades the harmful greenhouse gases they still contain.
What can we do?
To reduce the carbon footprint of inhaler prescribing:
- Ensure correct diagnosis: Optimal treatment requires an accurate diagnosis. Use peak flow and historical spirometry to help confirm diagnosis.
- Optimise asthma and COPD care: Follow national and local guidelines (S&W, N&E) to ensure patients are prescribed treatment suitable for their symptoms.
- Offering patients, a change from non-salbutamol MDIs to Dry Powder Inhalers (DPIs) where appropriate and safe to do so, and via shared decision-making: Can the patient take a quick, deep breath? If so, consider a DPI. If an MDI is required avoid those that contain HFA227ea (which has a much higher carbon footprint than the HFA134a used in other MDIs) such as Flutiform MDI, Symbicort MDI and Ventolin MDI).
- Reduce over-reliance and over-prescribing of short-acting beta-agonists (SABAs) inhaler: Over-reliance on reliever inhalers must be reviewed. Asthma may not be well controlled if:
- A reliever inhaler is used three or more times a week.
- Three or more reliever inhalers per year are needed.
- Increase the use of preventer inhalers, where clinically appropriate.
- Teach patients appropriate inhaler technique and encourage proper use: Choose the right inhaler for the patient. Assess inhaler technique before starting treatment and at annual review. Patients cannot use their inhalers unless they are being issued, preventer adherence can be checked using the repeat prescription record.
- Encourage patients to return all used or unwanted inhalers to community pharmacies or dispensaries for disposal by incineration.
Local data
OpenPrescribing features two measures relating to the carbon footprint of prescribed inhalers.
- Salbutamol metered dose inhalers (MDIs) are the single biggest source of carbon emissions from NHS medicines prescribing. Reducing over-reliance of salbutamol or switching to lower carbon salbutamol inhalers can aid in reducing this measure. There is a comparison table of the environmental impact of inhaler devices available on Devon Formularies (S&W, N&E)
- Dry powder inhalers or soft mist inhalers are generally preferred locally, unless there is a specific clinical or dexterity reason that an individual requires an MDI or BAI.
Continue to next page: Suggested Project Ideas and Resources to Support Practices.
