Improving Outcomes for Respiratory Patients

Medicines account for 25% of emissions within the NHS, with inhalers contributing a significant proportion.

In response to the urgent need to reduce global greenhouse gas emissions, the NHS has committed to reduce its carbon footprint to net-zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032.


Asthma and COPD are two of the most common health conditions, with several million people in England using inhalers to manage their condition, the most frequently prescribed being pressurised Metered Dose Inhalers (pMDIs) and Dry Powder Inhalers (DPIs). More than 26m prescriptions for pMDIs were written in primary care in England in 2016/17. pMDIs have estimated carbon footprints of 500g CO2 equivalence per dose, compared to 20g in DPIs. pMDIs currently use hydrofluorocarbon gases (HFCs) as propellants and when released from the inhaler they remain in the atmosphere for approximately 270 years. These are potent greenhouse gases between 1,300 and 3,350 times greater than CO2.

SABA prescribing in Tees Valley CCG is amongst the highest in the country, versus other CCG footprints.

Asthma is a significant burden, with 4.5 million people currently receiving treatment in England alone. Overuse of asthma reliever inhalers or Short Acting Beta Agonists (SABAs) was reported earlier this year to be a major contributor to CO2 emissions in respiratory care. Over-use of SABAs was also linked to asthma deaths in the National Review of Asthma Deaths (2014) and is a significant indicator of poor asthma control. Since most SABA prescriptions are issued using pMDIs, addressing and improving disease control can reduce SABA usage significantly and at the same time, the opportunity to change delivery device to DPI can be utilised.

COPD also represents a significant burden, with an estimated 3 million sufferers in the UK (many yet undiagnosed). QOF figures identify 21,475 patients within TEES Valley CCG, we estimate that around half of these will currently be prescribed triple therapy (inhaled corticosteroid / long-acting beta-agonist / long-acting anti-muscarinic). We also estimate that around 50% of these will use multiple inhaler devices to deliver these medications. We intend to offer, where clinically appropriate, the same medicines through a single inhaler device. This represents a £12.00 cost-saving per change, together with a significant Carbon reduction. A conservative estimate would be of a potential £300,000 savings across the CCG in one year. We are also aware that many patients are prescribed unhelpful/unnecessary medicines in COPD and we would again aim to bring potential health benefits in addition to carbon and cost savings by discontinuing such medications.


The project

This is an innovative Quality Improvement Proof-of-Concept study we are hoping to implement in two PCNs – Holgate & Greater Middlesbrough

Scheduled to commence in January 2022, the objectives of this project are as follows:

  • To reduce the carbon footprint of inhalers used by patients
  • To significantly reduce the disease burden of patients with asthma and COPD
  • To improve system integration and multi-disciplinary team working across Primary Care & Community Pharmacies


For further information about the project please contact Clare Adams, Health Programme Manager [email protected]