Learn which inhalers have a high carbon footprint to inform you when choosing an inhaler with your respiratory patient

Download the NICE inhaler decision aid now1

The UK government declared a “climate emergency” on May 1st 2019

1.

The NHS is committed to cutting carbon emissions by 34% by 20202

2.

The NHS Long Term plan aims for a shift to low carbon inhalers to deliver a 4% reduction in carbon footprint2

3.

MDIs have a high carbon footprint and DPIs have a low carbon footprint3

BTS encourages all prescribers and patients to consider switching pMDIs to DPIs whenever they are likely to be equally effective4

Do you currently consider the environmental impact of inhalers when prescribing inhaled medication?

The impact different inhalers have on the environment

MDI
  • MDIs (metered dose inhalers)
  • They use hydrofluorocarbons as a propellant1
  • These inhalers usually have a higher carbon footprint than DPIs3
DPI
  • DPIs (dry power inhalers)
  • These do not use any propellant as they are breath actuated1
  • These inhalers usually have a lower carbon footprint than MDIs3

A high carbon MDI inhaler has a carbon footprint that is 18x higher than a low carbon DPI inhaler5

Inhaler Environmental Impact Comparison
3.5%

(798k tonnes)
of the NHS total carbon emissions are from MDI inhalers6

MDI Carbon Emissions
  • MDIs contain hydroflurocarbons7
  • Hydroflurocarbons are in the propellant in MDIs7
  • Hydroflurocarbons are greenhouse gases that have a global warming effect of 3,800 times that of CO23
  • Therefore, these inhalers have a far higher carbon footprint than those that don't contain propellant, such as DPIs.
70%

of all inhalers dispensed in the UK are
high carbon inhalers6.

MDI 70%

Although MDIs are less harmful to the ozone layer than they used to be, some healthcare professionals may be unaware of their environmental impact.

The UK prescribes proportionately far more MDIs than European countries. Only 10% of inhalers dispensed in Sweden are high carbon MDI inhalers3.

MDIs however may still be the appropriate option for some patients and play an important role where there is clinical need and a DPI is not appropriate.

HCP solutions – What can you do?

Local NHS can help the NHS reach their carbon targets by:

  1. Making use of the NICE Decision aid and raising clinician awareness to its recent publication. This can assist in making appropriate inhaler choices, which include environmental considerations
  2. Championing change at a local level by advocating that low carbon DPIs are available for appropriate patients through local formularies
  3. Raising awareness for yourself and your colleagues on the environmental impact of inhalers

Download the NICE inhaler decision aid now8

Make use of the NICE decision aid with your patient in the next inhaler review in your diary

You can also DOWNLOAD the user guide to the NICE decision aid here.1

NHS Plans

NHS England has committed to offering patients a low carbon (DPI) inhaler choice in its new Long-Term Plan and will support pharmacists as part of a patient medicines review to ensure patients are using their inhalers correctly

  1. The NHS Long Term plan aims to reduce carbon emissions by 34% by 2020 and 51% by 2025. A shift to lower carbon inhalers will deliver a reduction of 4%2
  2. This could also reduce medicine wastage and the inappropriate prescribing of short-acting bronchodilators (SABAs).2

The EAC recommends the NHS set a target that by 2022 at least 50% of prescribed inhalers are low carbon inhalers.8

Recommendations

1.

British Thoracic Society

The British Thoracic Society “encourages all prescribers and patients to consider switching pMDIs to DPIs whenever they are likely to be equally effective”. However, MDIs still play an important role, where there is a clinical need or where a DPI is not suitable.4

2.

The NHS

The NHS encourages pharmacists to support patients on inhaler technique and support patients to reduce the use of short acting bronchodilators and switch to DPIs where clinically appropriate, which use significantly less fluorinated gases than MDIs.

A shift to low carbon inhalers will lead to a 4% decrease in NHS carbon emissions2

3.

British Lung Foundation

"The propellants in pMDIs are a powerful greenhouse gas... While a single inhaler doesn't have that much impact, combined they soon add up... If you use an pMDI it may be worth discussing your treatment with your doctor or respiratory nurse to see if changing would be a good idea". Dr Nick Hopkinson, BLF Medical Director5

Will you now consider environmental factors when prescribing inhaled medication?

References

  1. National Institute for Healthcare and Excellence: asthma patient decision aid user guide: https://www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patient-decision-aid-user-guide-pdf-6727144574
  2. The NHS Long Term Plan: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan.pdf
  3. Hillman, T. Mortimer, F and Hopkinson, N. (2013). Inhaled drugs and global warming: time to shift to dry powder inhalers. British Medical Journal. DOI: 10.1136/bmj.f3359.
  4. British Thoracic Society (BTS) (2019) Position Statement: Environment and Lung Health. https://www.brit-thoracic.org.uk/document-library/governance-and-policy-documents/position-statements/environment-and-lung-health-position-statement-2019/
  1. British Lung Foundation (2019). Which inhalers are kindest to the environment. Accessed: https://www.blf.org.uk/your-stories/which-inhalers-are-kindest-to-the-environment
  2. EAC (2018) UK progress on reducing F-gases. https://publications.parliament.uk/pa/cm201719/cmselect/cmenvaud/469/469.pdf
  3. Labiris and Dolovic (2003) Pulmonary drug delivery. British Journal of Clinical Pharmacology. DOI:10.1046/j.1365-2125.2003.01893.x
  4. National Institute for Healthcare and Excellence: asthma patient decision aid. https://www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patient-decision-aid-pdf-6727144573