From December, the listings for dry powder and soft-mist inhalers in the quarterly print edition of MIMS are being flagged with a leaf symbol to indicate that these devices are associated with significantly lower carbon emissions than pressurised metered-dose inhalers (MDIs).
The change is intended to help prescribers opt for the most environmentally friendly option when faced with a choice of suitable devices, in line with NICE guidance. The meaning of the symbol is explained to readers in the key at the front of the MIMS book.
MDIs have a carbon footprint 18 times that of dry powder inhalers because the propellants they contain are highly potent greenhouse gases. MDIs account for almost a quarter of the carbon footprint of general practice prescribing, and 13% of the entire carbon footprint of general practice.
Incentives to reduce prescribing of MDIs recently came into force as part of the Investment and Impact Fund (IIF) of the PCN Contract DES. The IIF, which is voluntary, introduces a target for practices to reduce the proportion of MDIs they prescribe as a percentage of all non-salbutamol inhaler prescriptions in patients 12 years or over, and a separate target to reduce mean carbon emissions per salbutamol inhaler prescribed.
NHS England is currently aiming for just 25% of non-salbutamol inhalers prescribed across the NHS to be MDIs by 2023/24.
NHS England recommends that all inhaler prescriptions, structured medication reviews or planned asthma reviews taking place in primary care 'should consider moving or facilitating patients to lower carbon options where it is clinically appropriate to do so'. It says that research suggests most asthma patients using MDIs would change device for environmental reasons as long as the new inhaler was as effective as their current medication.
The leaf symbol will be added to the MIMS inhaler listings online in due course.