Suggested Project Ideas and Resources to Support Practices.

Project 1: Ventolin Evohaler MDI to Salamol MDI or Airomir MDI

  • Greener Practice resources: webpage includes, SMS and Letter templates, and a step-by-step process to action this piece of work.
  • Salamol letter template: Your salbutamol inhaler is changing to a more environmentally friendly version – Salamol®

Project 2: Targeting high carbon footprint preventer inhalers

Flutiform (fluticasone /formoterol)

The routine commissioning of Flutiform is not accepted in Devon for the treatment of asthma in adults and children over 12 years (see Commissioning Policy for more details).

Symbicort MDI

This item is non-formulary and has a high carbon footprint (See PrescQIPP carbon footprint data for more details)

Greener Practice resources: webpage includes, SMS and Letter templates, how to set an alert on patient records to show that lower carbon inhaler options are available and a step-by-step process to action this piece of work.

Project 3: Limit repeat SABA prescribing

Patients whose asthma is not well controlled and who need to frequently use SABA inhalers are at higher risk of a serious asthma attack, which could be fatal as shown by the data presented in the NRAD report. Reviewing and optimising patients’ asthma preventative therapy should lead to an improvement in asthma symptoms, reduction in the likelihood of a serious attack, and ultimately save lives and reduce carbon emissions.

BTS/SIGN define severe asthma as patients who have more than two asthma attacks a year or persistent symptoms with SABA use more than twice a week. SABA inhalers therefore should not be required more than twice per week. The risk of severe exacerbations and mortality increases incrementally with higher SABA use, independent of treatment step.

Consider the following actions:

  • Prioritise higher users of SABAs (12 or more in last 12 months) as stipulated by the NRAD report.
  • Carry out a desktop review of identified patients to determine whether a change or escalation in therapy is needed.
  • Recall patients where appropriate to assess:
    • Patient understanding of asthma and their treatment.
    • Inhaler technique (including use of spacers)
    • Adherence to therapy
    • Smoking status (and offering appropriate smoking cessation advice where appropriate)
    • Lifestyle and asthma triggers
    • The patient’s treatment in line with national and local guidance
    • The patient’s asthma action plan, ensuring it meets patient’s needs and is used to agree goals
    • Utilising tools to assess reliance on SABA inhalers
  • Following assessment, escalate patient’s treatment and/or provide education as necessary.
  • Arrange for patient follow-up as necessary.

Consider Implementing changes to repeat prescribing processes to reduce future SABA overuse by patients. Examples include:

  • Taking SABA off repeat (or repeat dispensing) and putting on acute
  • Changing issue duration or maximum issues
  • Issue two SABAs at annual review and explain that good asthma control should mean that they will not need any more until their next review
  • Not issuing more than 1 SABA inhaler at a time
  • Ensuring patients are ordering their preventer inhalers
  • Ensure all patients have a personal asthma action plan in place
  • Prioritise patient education on consequences of SABA overuse
  • Consider MART regimes (without issuing SABAs at all)
  • All staff to be aware and flag patients who frequently request SABA inhalers

Suggested SMS template:

If you need to use two or more reliever (blue) inhalers a year, this more than doubles your risk of an asthma attack. To ensure we identify patients whose asthma control needs improvement, our systems will no longer allow patients to receive more than five rescue (blue) inhalers a year without a check from a healthcare professional. For more information have a look at this video or read this leaflet.

Or

Information on good asthma control: good asthma control means you will rarely or never have symptoms such as wheezing, chest tightness, cough, or shortness of breath. Many people do not realise their treatment could be improved. To learn more, watch this video or read this leaflet. If you need three or more salbutamol (blue /reliever) inhalers a year, this could mean your asthma control needs improvement. Book an asthma review to discuss.

Project 4: Inhaler waste management

Inhalers should not be recycled or disposed of with household waste so patients should be encouraged to return them to pharmacies.

Suggested SMS template:

How to tell if your inhaler is empty: Do you know how to tell if your inhaler is empty? Ask your pharmacist or check here for more information.

Inhaler disposal: Did you know your inhaler should be disposed of safely by your pharmacy, not put in the bin at home?  Return your inhaler to the pharmacy – this protects the environment. For more information see ‘Return your used Inhalers to pharmacy to help reduce your carbon footprint’ leaflet.

Continue to next page: Further Additional Resources