Helping achieve NHS targets to deliver reduced emissions by moving to lower carbon inhalers

• NHS Long Term Plan set targets to deliver significant and accelerated reductions in the total emissions from the NHS by moving to lower carbon inhalers, such as dry powder inhalers (DPIs)
• A pharmacist working group in Sussex has developed some resources to be used in GP practices to help facilitate a conversation between HCPs and patients around the environmental effect of inhalers
• A “Green Inhaler guide” has been developed to be launched later this month (July 2021). The guide contains suggestions of moving appropriate patients from MDIs to DPIs
• Pharmacies need to be aware they will see changes in prescribing to dry powder/lower CO2 inhalers in the future

^{This is a guest item from Fionnuala Plumart, senior medicines optimisation pharmacist with Sussex Commissioners (NHS Brighton and Hove CCG, NHS East Sussex CCG, NHS West Sussex CCG)}

Both health care professionals (HCPs) and patients are sharing growing concerns about the impact of respiratory inhalers on our environment, as the UK  prescribes around 50million inhalers a year.¹

The majority of those inhalers (approx. 70%)² are metered dose inhalers (MDIs) which contain propellants called hydrofluorocarbons (HFCs) that are potent greenhouse gases, thousands of times more powerful than carbon dioxide.

The most commonly prescribed inhaler in the UK, Ventolin Evohaler MDI has a carbon footprint equivalent(Co²e) of 28kg of CO2 (per whole inhaler) – the same carbon footprint as the greenhouse gas emissions of driving 175miles in a small car!³

Dry Powder Inhalers do not contain propellants and have a small fraction of the carbon footprint of MDIs (typically less than 1kg). ³

The NHS Long Term Plan set targets to deliver significant and accelerated reductions in the total emissions from the NHS by moving to lower carbon inhalers, such as dry powder inhalers (DPIs).

To help facilitate a conversation between HCPs and patients around the environmental effect of inhalers a pharmacist working group within Sussex Commissioners have developed some resources to be used in GP practices in Sussex. Our intention is for these resources to be used by GPs, practice nurses, PCN pharmacists etc when carrying out respiratory reviews or Structured Medication Reviews(SMRs) with patients.

A pharmacist working group in Sussex has developed a “Green Inhaler guide” where we offer suggestions of moving appropriate patients from MDIs to DPIs. However if this is not a suitable option, other actions that can be taken include

• Prescribing Salamol MDI rather than Ventolin MDI or generic as Salamol MDI has a lower volume of propellant and therefore has a lower carbon footprint than Ventolin (10kg of CO2 equivalent instead of Ventolins 28kg of CO2 equivalent).
• Encouraging patients to return their used inhalers to their community pharmacy to be incinerated (as this is better than inhalers going to landfill).

The resources will be launched in July 2021 and as time goes by and practices have more capacity to have these conversations with patients, community pharmacies in Sussex should see an increase in prescriptions for Salamol MDI (Salbutamol). It would be great if Salamol MDI also becomes the chosen Salbutamol MDI against generic scripts.

There should also be an increase in DPI prescriptions over MDIs and patients might need extra reassurance and support if they are picking up their new inhalers. We would greatly appreciate community pharmacy support with this very important movement

References

1. https://www.thedatalab.org/blog/77/new-measure-inhalers-and-the-environment
2. https://www.greenerpractice.co.uk/inhaler-switch
3. org The problem with Inhalers

^{Source:  This is a guest item from Fionnuala Plumart, senior medicines optimisation pharmacist with Sussex Commissioners (NHS Brighton and Hove CCG, NHS East Sussex CCG, NHS West Sussex CCG)}