Abstract

Background
Chronic respiratory disease is one of five clinical areas of focus which require accelerated improvement in the NHS Core20PLUS5 framework. 1 Inhaler emissions account for approximately 3% of the NHS carbon footprint. The propellant used in metered dose inhalers is responsible for most of these emissions.2 Primary care continues to face workload pressures and backlog in routine COPD care, necessitating scalable models to support guideline-aligned optimisation.
Aims
To reduce general practice workload and improve COPD outcomes through structured pharmacist-led therapy reviews,3 focusing on symptom control, exacerbation risk reduction, delivery of annual review components, and sustainable prescribing.
Methodology
Patients on COPD registers were stratified by symptoms and exacerbation risk and invited to pharmacist-led clinics. Holistic reviews included symptom assessment (CAT/MRC), inhaler technique evaluation, adherence assessment, and optimisation of pharmacological and non-pharmacological management.
Results
20,520 patients were reviewed on 1537 clinic days in 330 GP practices. 89% (18,345) of these patients had evidence of symptoms and/or exacerbations in their medical record.
75% of all patients reviewed had a pharmacological intervention.
24% (4,935) patients had their therapy escalated and a further 46% (9,541) had their overall therapy level maintained but a change of inhaled therapy device and/or molecule.

96% patients had a non-pharmacological intervention such as inhaler technique coaching, smoking cessation referral or pulmonary rehabilitation referral.
Sustainable prescribing improved: 5945 devices were transitioned from higher carbon to lower carbon (DPI/SMI): 2254 higher carbon devices were stopped, resulting in 78% of maintenance therapy devices and 83% of reliever therapy devices being lower carbon (DPI/SMI) post-service, representing relative increases of 50% and 419%, respectively.
Conclusions
Pharmacist-led COPD therapy review services delivered at scale can improve clinical management, address unmet care needs, and support NHS Net Zero ambitions, while reducing pressure on primary care.

1. NHS England. Core20PLUS5 (adults) – an approach to reducing healthcare inequalities. https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/ Assessed 30th June 2026
2. NHS England. Improving health outcomes for respiratory patients while reducing carbon emissions https://www.england.nhs.uk/greenernhs/whats-already-happening/improving-health-outcomes-for-respiratory-patients-while-reducing-carbon-emissions/
3. This service was funded by GlaxoSmithKline UK Limited as a donation freely given for the purpose of supporting healthcare.