PCRS Position Statement: Inhaler Switching: Making safe and clinically appropriate changes for patients with respiratory disease (Update)

Concerns about the environmental impact of the propellant gases used in pressurised metered dose inhalers (pMDIs) and the plastics used in all single-use inhaler devices have made them an important focus for efforts to reduce the environmental impact of the NHS. Patients themselves may also be concerned about the environmental impact of their inhalers and express a preference for alternatives. In addition, Integrated Care Boards (ICBs) in England, as well as healthcare commissioners’ services in other devolved nations, are under financial pressure to reduce the costs of medicines, which includes inhalers.

The Primary Care Respiratory Society (PCRS) believes that optimising treatment, adherence and inhaler technique to gain the best possible symptom control is key to reducing the environmental impact of treatment and the waste of inhalers. Appointments to review a patient’s inhaler treatment or respiratory condition should be used as an opportunity to improve outcomes, including a regular observed review of inhaler technique.

PCRS supports initiatives to reduce the environmental impact of respiratory care provided that patient outcomes are not compromised.

PCRS does not support blanket switching of inhalers. Such approaches:
• Are not patient-centred
• Risk worsening disease control
• Do not represent good clinical practice

All decisions regarding inhaler changes must:
• Be made collaboratively with the patient, taking into account equity of access to engage with shared-decision making and adapting to their inhalers
• Be based on a clinical review by an appropriately trained healthcare professional
• Prioritise optimal individual patient care
 

Environmental considerations are important but must not override clinical safety and effectiveness.