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Greener Practice : Inhalers and the Carbon Footprint

Prescribing accounts for two-thirds of a modern general practice's carbon footprint. That is why it is critical to attempt to minimize needless prescriptions and to be aware that some medicines have a greater environmental impact than others.

Medicines account for up to 25% of emissions within the NHS, with inhalers making up 3% of these emissions. The Delivering a Net Zero NHS policy outlines possible interventions including optimising prescribing, substituting high carbon products for low-carbon alternatives, and improvements in production and waste processes.

Carbon Footprint of Inhalers

The NHS Long Term Plan (LTP) aims to make the NHS more sustainable and decrease its negative environmental impact. It highlighted inhalers as an area where practice adjustments might help the NHS reduce its carbon footprint.

Inhalers are commonly prescribed to people with respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD) and there were over 50 million prescriptions for them across England in the last 12 months.

The most recent GMS contracts now include a goal for practices to reduce MDI (Metered Dose Inhaler) prescriptions as a percentage of all inhaler prescriptions. Where clinically appropriate, patients should be offered the option of switching to DPI (Dry Powder Inhalers), which are far more environmentally friendly.

Where clinically appropriate, patients should be offered the option of switching to DPI (Dry Powder Inhalers), which are far more environmentally friendly.

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In the UK alone, 25,000 people die each year from chronic obstructive pulmonary disease (COPD), and the NHS spends £420 million each year on treatment, emitting an estimated 1 tonne of CO2e per episode. Around 70% of inhalers prescribed in the UK have high levels of greenhouse gases - compared to around 10% in Sweden.

A 50% cut in the carbon footprint of inhalers would save nearly 4% of the total carbon saving needed for the NHS to meet its 2030 carbon reduction target.

Prescribing the right inhalers

The MDIs (Metered Dose Inhalers) contain hydroflurocarbons as a propellant to get the medicine quickly to the lungs in an asthma attack, which has an estimated carbon footprint of 500g CO2 equivalent per dose. Five doses from an MDI is equivalent to a 9-mile car trip.

As a comparison, dry powder inhalers (DPIs) have 20g per dose, although these are only recommended for patients who experience more milder attacks. Where there are lower carbon versions of MDIs available, such as Salamol instead of Ventolin Evohaler, CCGs were promoting these as the preferred option for prescribing.

For most people, either type of inhaler will work just as well, but most important is using them the right way. In many cases a DPI inhaler can be easier for a patient as they have a dose counter which reduces wastage, it does not need a spacer device, and it can be easier to co-ordinate with breathing.  Most people, once shown the correct technique, can master a DPI but they are not suitable for everyone.

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Recycling/Disposing of Inhalers

Inhaler disposal has a harmful influence on the environment if it’s not done correctly. Used pMDIs still contain some hydrofluorocarbons that can contribute to global warming. All inhalers, including used pMDI canisters, should be returned to any pharmacy for disposal in an environmentally safe way.

Companies like GSK (GlaxoSmithKline) has a recycling and recovery programme that allows patients to dispose of their old inhalers while picking up their prescription at pharmacies, hospitals, and dispensing clinics around the country. Initiatives like these encourage proper inhaler recycling,

Appropriate Prescribing/alternatives for patients

If it’s possible to switch a patient’s inhalers then the general directive is to do so, whether at an annual review or as an appointment (it may be a good opportunity to ask them to bring all of their current inhalers to the appointment or phone review).

At the review, a healthcare professional will review your condition, ask about symptoms, check their progress using the inhalers they have, and discuss whether switching to a greener inhaler would be suitable.

However, switching to DPI may not always be appropriate, and there are various factors to consider when determining the type of inhaler to prescribe;

  • Available alternatives — Some inhalers are only available as an MDI.
  • Clinical suitability — Some patients may not be able to use a DPI effectively (e.g. those with low inspiratory flow rate), and it may not be clinically appropriate to switch.
  • Specific HFC in an MDI — Some MDIs have a bigger impact than others, so if the medication has no DPI alternative, there may be an MDI alternative with a lower ‘global warming potential’ (GWP).
  • Local formulary choice — Most areas have a local formulary that will make recommendations based on cost, evidence, and local services available

You can check your personal carbon footprint at the following link using the WWF’s calculator. Small businesses can try this GP Carbon Calculator or visit the Energy Saving Trust.

To find out more about The Green Practice Network, email greenerpractice@gmail.com.


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