Ideas for prescribers
Have a look at this guide on Reducing the Carbon Footprint of Inhaler Prescribing written with input from the GreenerPractice team, and recently endorsed by Asthma UK, British lung foundation and the NHSE/I inhaler experts working group. The Asthma toolkit is also a fantastic resource aimed at primary care in the UK.
Avoid HFA-containing placebos. Here’s a great HFA-free placebo alternative that never runs out.
Make sure you are confident teaching effective inhaler technique for all the commonly used inhalers on your formulary. Prioritise inhaler technique training in your hospital education programs for doctors and nurses. Make every puff count!
Focus your attention on patients who use a lot of salbutamol MDIs. These patients have poor control and are at risk of exacerbations; they also have a large carbon footprint. Review diagnosis and inhaler technique, and consider alternative treatment strategies to improve maintenance therapy, in particular once-daily long-acting maintenance therapy, or maintenance and reliever therapy (MART) in asthma. Both strategies are popular with patients, can improve disease control, reduce exacerbations and cut carbon footprint.
Ideas for hospitals
- Make sure that any inhalers you dispose of go into medicines waste. When incinerated, the HFAs degrade into far less potent greenhouse gases.
- If you have patient information leaflets, make sure you include information on how to recycle inhalers. If you don’t have patient information leaflets – make some!
- Ensure your hospital formulary has a full range of dry powder and metered dose inhalers in stock. This gives you more options for selecting the right inhaler for your patient and offering low global-warming-potential choices. Make sure you know the difference between an Easi-breathe (breath-actuated MDI) and Easyhaler (DPI)
- If you have accurate digital scales on the ward consider weighing patients’ Ventolin inhalers to check how many doses are remaining. You may be surprised to find that some patients are unknowingly using empty Ventolin inhalers (12% when we checked) and that patients think their inhaler is empty, even when it is quite full. Weigh Ventolin inhalers before disposing of them too.