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Consider wider clinical issues before switching to green inhalers


Switching respiratory patients to alternative, greener inhalers could achieve large carbon savings and reduce drug costs by using less expensive brands, reports a new study.

But PCRS advises that wider clinical considerations - such as ensuring the patient has an accurate diagnosis, regular respiratory reviews and is using their inhaler correctly - should also be taken into account when thinking about green healthcare issues.  

Using NHS prescription data from England in 2017, researchers analysed the financial and environmental impact of switching patients away from metered-dose inhalers (pMDIs), which contain propellants which are potent greenhouse gases, to more eco-friendly dry powder inhalers (DPIs).

They found that the carbon footprints of MDIs were between 10-37 times those of DPIs. Replacing one in ten pMDIs in England with the cheapest equivalent DPIs would reduce drug costs by £8.2million annually and carbon dioxide equivalent emissions by 58 kilotonnes.

Currently MDIs contribute an estimated 3.9% of the carbon footprint of the NHS. In 2017 around 50 million inhalers were prescribed in England, of which seven out of ten were pMDIs compared to only one in ten in Sweden.

PCRS Executive Chair Carol Stonham says: “This study gives clinicians and patients some valuable food for thought about the impact of inhalers on the environment. However switching from pMDIs to DPIs or soft mist inhalers (SMIs) should only occur on an individual basis when the clinician is face to face with the patient. We do not support policies that advocate ‘blanket switching’ of patients from one inhaler type to another."

“This concern about inhalers is just one part of a bigger picture about delivering healthcare that is cleaner and kinder to the environment. This agenda should involve clinicians taking opportunities to think about environmental issues during the whole patient journey. They can do this by ensuring respiratory patients have an accurate diagnosis, regular reviews and are using their inhalers correctly. This will help to prevent repeated unnecessary healthcare appoint­ments and tests and unnecessary transportation of ineffective medication.”

PCRS has launched a #nowaste campaign which will improve education of healthcare professionals, patients and the public about environmental health issues, influence guidelines and pol­icy, work with suppliers of medication and recycling schemes.

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