FAQs
If you are a patient or healthcare professional and have a question please post it here. I can’t guarantee I’ll be able to respond to all your questions, but I’ll do my best, especially if the same question comes up frequently.
If you are from a drug company I will only respond if you have found a factual error in our work or you have new information that has been in some way independently verified, that you are willing to put in the public domain about the carbon footprint of your products. If you do have this information though, we’d love to hear from you.
Green Inhaler 
If we acknowledge you as the author, can we use this information to create an adapted document to put on practice website that identifies our local pharmacies involved in the recycling programme and the appropriate person at our practice to contact?
If you agree we would also like to share the adapted document with other local practices to encourage change locally in Rugby
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Great. Please feel free to use it in this way. I’ll email you off-line with some more resources too.
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Hi Alex, this is such a great resource thanks. I am a GP trainee planning to do a QIP on eco-halers. Can I also acknowledge you as an author and use some of the content to create a patient leaflet? Cheers
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Dear Greg. Thanks for your feedback. Please feel free to use it.
Alex
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Hi Greg, a leaflet sounds like a great idea. Would you consider joining the RCGP Climate Advisory Group to share your work?
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For Your Information – Are you aware that GSK are now discontinuing the complete the cycle scheme as they ” believe there should be a focus on a wider joint-working approach across the industry, rather than a stand-alone approach”.
I had recently produced a leaflet regarding recycling inhalers for hospital patients after auditing and finding only 1 out 10 patients returned their inhalers to the pharmacy (the others put in the bin).
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Thanks for your message. I had heard. Looks like it’s going to stop in a couple of months. I haven’t got round to updating the site yet.
Your study sounds interesting. Do you hope to publish? There’s not much known about how patients dispose of inhalers but it’s an important topic.
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Hi Alex, hope you’re well? I’m a journalist and am writing a piece about green GP practices. Do you have an email address I could drop you a line on to ask a few quick questions? (Or you can email me – jessicapowell.freelance@gmail.com). Thanks!
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Hi interesting site! I wonder do you know if there is a Dry Powder version of Fostair ? Just asking so I can have the info for when I speak to Practice Nurse!
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There is. It’s called fostair nexthaler. Not always available in all areas. Best of luck. Alex
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Hi
I am a retired GP who does some clinical computer support work for a large 70 000 patient practice in Worcestershire.
Really interesting website and material. One of the current partners is keen to reduce carbon foot print for medication and we are looking at options – in particular I am keen to not overburden the respiratory nurses where much of this work will fall to and hence am looking ways of fractionating the issue to look for the biggest impact for lowest staff use/hr.
Hence are you aware of any previous work/resources that allows one to identify the most straightforward swaps with best carbon impact and least financial impact for drug budget. For example I can see that across all 5 sites, we issue approximately 6000 Ventolin evohalers/yr and a straightforward change to Salamol MDI could reduce carbon from approx. 168 tonnes to approx. 35 tonnes with minimal impact on patients in terms of familiarity of device and drug budget.
That is a very simple example but I have always worked on the basis that simple changes are likely to produce immediate benefit and more complex and across the board changes are difficult to actually get completed!
Also are you aware of a low carbon respiratory formulary that will meet NICE (assuming patient suitability etc) reduce carbon without bankrupting the drug budget?
I look forward to any thoughts you might have. Impressed by what you are advocating.
Best wishes
Iain Inglis, Bewdley
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Hi Iain.
Thanks for your interest. The website http://www.greener practice.co.uk/inhaler-switch will hopefully be of interest. I should add a link from my site. There is a guide by Dr James Smith that includes a mini formulary.
Ventolin salamol switch is definitely the easiest and I understand this has even been started at a CCG level in some places.
In terms of drug budget there is potential to save money by optimising combination treatments, though salbutamol is going to be more expensive.
https://bmjopen.bmj.com/content/9/10/e028763
Personally I’d like to see much more resource going in to airways disease treatment in terms of time and medicines investment, particularly using combination DPI as maintenance and reliever therapy, that removes the need for salbutamol entirely. I accept this takes more resources though.
https://www.researchgate.net/publication/340892298_Asthma_maintenance_and_reliever_therapy_Should_this_be_the_standard_of_care
Yours,
Alex
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Hi Alex,
I’ve been asked about the cost impact of prescribing DPIs instead of MDIs (which in an ideal wouldn’t be an issue.. but in NHS reality it is). Do you know of any comparative tables?
Thanks
Jenna
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Hi Jenna. I published this in bmj previously
https://bmjopen.bmj.com/content/9/10/e028763
Rightbreathe website is also very useful. Alex
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Hi Alex. Do you have any LCA information about nebulised salbutamol. I work in a Paediatric ED and it would be useful to compare nebulised salbutamol to inhaled via spacer.
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Hi. Hopefully this helps. The nebuliser has a smaller carbon footprint than this small volume mdi. Ventolin evohaler has a carbon footprint 2.8 times greater than the inhaler used in this comparison.
Sustainability 2017, 9(10), 1725; https://doi.org/10.3390/su9101725
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Dear Alex
thanks a lot for your work. This website as well as your scientific work lead to the idea of formulating a guideline (not only for Primary Care) to support the change from pMDI. Finally, we made it and produced a guideline on behalf of the German College of General Practitioners and Family Physicians. To further support its use an English version was produced. This guideline is available at https://doi.org/10.26092/elib/1765 and we hope it will help “in making your inhaler more environmentally friendly”.
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This is really great, and thanks for your kind comments. Your document is great. I need to make a new post on this on my website, but in the IPCC assessment report 6 the GWP estimates of HFCs has been changed slightly. According to the latest information HFA134a is now thought to have 100-GWP of 1540 and HFA227ea is 3600, so slightly more than we previously thought and more than in your document. – see page 29 of https://www.ipcc.ch/report/ar6/wg1/downloads/report/IPCC_AR6_WGI_Chapter_07_Supplementary_Material.pdf
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Dear Alex
thanks for this information. We are already in the process of updating the guideline and will change the numbers regarding the GWP
Kind regards
Guido
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