A greener NHS – Reducing the environmental impact of asthma inhalers

8th February 2022

Recognising climate change’s threat to health, the NHS has become the world’s first healthcare system to commit to reaching carbon net zero by 2040. To support this mission, the AHSN NENC is working with partners across a range of disciplines to deliver innovative sustainability solutions.

Medicines account for up to 25% of emissions within the NHS, with inhalers making up 3% of these emissions. This is a national problem, as the propellants in metered-dose inhalers (MDIs) are powerful greenhouse gases.

In this blog, our Programme Manager, Dr Sean Gill, takes us through a project delivered by the AHSN NENC to improve outcomes for patients with respiratory illnesses, which promotes better care and environmentally sustainable management of inhalers for people with asthma and chronic obstructive pulmonary disease (COPD) in the Tees Valley. 

Since January 2021 I’ve been very fortunate to be involved in an exciting and growing programme of work around environmental sustainability in healthcare. This includes the ‘Improving Outcomes for Respiratory Patients’ project which addresses the environmental impact of asthma inhalers.

The problem

Inhalers are commonly used by people living with respiratory conditions such as asthma and COPD. 61.1 million inhaler items are prescribed annually and over 70% of these inhaler devices are MDIs. Because the propellants in these devices are powerful greenhouse gases, landfill disposal is harmful to the environment as residual gas from the canisters is released into the atmosphere. These greenhouse gases account for approximately 13% of the NHS’s carbon footprint related to the delivery of care.

The solution

The NHS Long Term Plan sets out targets to deliver significant and accelerated reductions in the total emissions from the NHS by moving to lower carbon inhalers, such as dry powder inhalers (DPIs). The Delivering a ‘Net Zero’ NHS report reinforced this by committing to reduce carbon emissions from MDIs by 403kt CO2e and committed to an additional 374kt of reductions by 2040 through further uptake of low carbon inhalers.

Achieving the required reduction in emissions from inhalers will therefore be made possible by a national NHS effort to:

  • Significantly increase the use of DPIs, which may be clinically equivalent for many patients, and come with significantly lower carbon emissions
  • Support the innovation in and use of lower carbon propellants and alternatives
  • Increase the frequency of the greener disposal of used inhalers.

From 2022/23, the Investment and Impact Fund will reward Primary Care Networks for increasing the percentage of asthma patients who are regularly prescribed an inhaled corticosteroid (ICS, or preventative inhaler), where clinically indicated. As well as improving patient health, it’s thought that this incentive will enable reductions in unnecessary SABA prescribing (and therefore carbon emissions) by improving disease control.

North East and North Cumbria project

Our project has been developed to support this plan; it’s a proof-of-concept study in two Primary Care Network (PCN) areas – Holgate (5 practices) and Greater Middlesbrough (8 practices).

The project involves a modular education programme targeting relevant healthcare professional groups. This will be followed by specific, template led, interventions by both General Practice and Community Pharmacy teams for targeted groups of patients to promote better management of asthma and COPD.

The primary objectives of the study are: to reduce the carbon footprint of inhalers used by patients; to significantly reduce the disease burden of patients with asthma and COPD; and to improve system integration and multi-disciplinary team working. A secondary objective of the project is to facilitate a collaborative project where clinicians and the pharmaceutical industry work successfully together for the benefit of patients.

People living with asthma and/or COPD of any age may be eligible for inclusion in the project. Five cohorts of patients will be targeted for project participation and identified through medication searches; these include:

  1. Inhaled steroid prevention: < 5 prescriptions / year
  2. Prescribing frequency of prednisolone 5mg tablets: 2 or more courses / year
  3. Excess SABA prescribing: 6 or more inhalers / year
  4. Patients on open triple therapy
  5. Patients on Respimat inhalers

Delivery of the education programme will commence this month, until April. Following a period of implementation and reporting, it is hoped that local and national dissemination through to adoption and spread will be from February 2023 onwards.

Communications toolkit to support carbon reduction relating to inhaler usage

In addition to the education programme, we are engaging with patients by promoting safer disposal of inhalers. Instead of throwing inhalers in household waste, we are encouraging the public to take their inhalers to a pharmacy, where inhalers can be disposed of in an environmentally friendly way.

To support this messaging, we’ve developed a communications toolkit for CCGs, GP Practices, and pharmacies. The toolkit provides readymade content, to be used and adapted for various communication channels.

AHSN Network event held on Tuesday 8th February – Delivering a Net Zero NHS: Reducing environmental impact of asthma inhalers

A national learning and sharing event was held by AHSN Network today (8th February) which shared best practice and learnings useful to those working in primary care, respiratory clinicians, pharmacists interested in respiratory and NHS sustainability leads. We’ll share a recording of the event on this page when it becomes available.

Find out more

If you have any questions or would like more information about this project, get in touch with Sean at [email protected]