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How switching asthma inhalers can help the NHS cut carbon emissions

The NHS long-term plan has committed to switching more patients to lower carbon inhalers as a way of reducing the NHS's carbon footprint, but what does this mean in practice?1

(Photo: iStock.com)
(Photo: iStock.com)

There are 5.4m people with asthma in the UK, which means the condition affects one in five households.2 The majority of these patients are prescribed pressured metered dose inhalers (pMDI)  - across the total UK inhaler market, the ratio of pMDI to dry powder inhalers (DPIs) dispensed is 70%:30%.3

However, these inhalers have different environmental impacts. The NHS Sustainable Development Unit has estimated that 3.5% of the NHS’s total carbon footprint comes from pMDIs,4 which have a carbon footprint approximately 18 times that of DPIs.5

Low carbon inhalers

#LowCarbonInhalers is a campaign funded by GSK aiming to raise awareness about how inhaler choice can play a role in reducing carbon emissions. For more information visit https://lowcarboninhalers.co.uk/

This article was initiated, funded and reviewed by GSK

NHS long-term plan

The NHS long-term plan for England has set out plans to increase the use of lower carbon inhalers.1 The plan says this could help reduce carbon emissions in the NHS in England by 4%.

As part of its vision for respiratory care, the long term plan suggests that pharmacists in primary care networks will be key to supporting patients to switch to DPIs, where clinically appropriate, as part of medication reviews.1

In April, NICE launched a new asthma ‘shared decision aid’,6 aimed at helping patients and their healthcare professionals discuss their options for inhaler devices. The carbon footprint of inhalers is included as a consideration during the discussion.

Meanwhile, the British Thoracic Society encourages all prescribers and patients to consider switching pMDIs to DPIs whenever they are likely to be equally effective.7

However, new market research conducted by GSK, has found that only a quarter (25%) of British people are aware that different inhalers have different environmental impacts.8

The research suggests that healthcare professionals are better informed than the general population, but many are still unaware of the environmental impact of inhalers. The survey of 550 healthcare professionals, including 242 GPs, found that 60% did not know that some preventer inhalers produce more greenhouse gases than others, while 67% were not aware that pMDIs produce more greenhouse gases than DPIs.9

Positive impact on environment

Dr Steve Holmes, a GP from Somerset and education lead for the Primary Care Respiratory Society says that switching inhalers could have a significant positive impact on the environment.

‘Everyone is much more aware of their impact on the environment,’ he says. ‘We are making many more green choices every day – reusable cups, bags, straws and other greener options. We are also becoming more aware of the total impact of respiratory inhalers, which includes the gas emissions, production and transportation costs, as well as the use of reusable plastics, metals and other valuable resources.

‘Halving the amount of emissions from inhalers would be equivalent to approximately 230,000 fewer cars on UK roads,10 it’s time to take action.’

Dr Holmes says that GPs should recognise that there is still an important role for pMDIs, including where there is a clinical need or where dry powder inhalers may not be suitable for the patient. ‘However, where clinically appropriate, patients should be offered a lower carbon inhaler choice, which, together with environmentally safe disposal, will make a positive impact on the environment.’ he adds.

Choice of inhaler11

A number of factors should be considered when prescribing an inhaler, these include:11

  • Pulmonary function – inspiratory flow and breathing technique
  • Device handling – manual dexterity is key, particularly for children and the elderly
  • Inhaler technique – correct inhalation required for optimal drug delivery
  • Spacer use – correct connection to device and method of use
  • Patient preference – engaging patients in device selection

Treatment efficacy is linked to adherence and individualising the device for the patient may help with treatment adherence, with an associated impact on long-term outcomes.11


  1. NHS England. The NHS Long-Term Plan. Available at: https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/
  2. Asthma UK. Asthma Facts and Statistics.
  3. Lavorini F, Corrigan CJ, Barnes et al. Retail sales of inhalation devices in European countries: so much for a global policy. Respir Med 2011;105:1,099-103
  4. House of Commons Environmental Audit Committee. UK Progress on reducing F-gas Emissions. April 2018. Available at: https://publications.parliament.uk/pa/cm201719/cmselect/cmenvaud/469/469.pdf
  5. Hillman, T. Mortimer, F and Hopkinson, N. Inhaled drugs and global warming: time to shift to dry powder inhalers. BMJ. 2013 DOI: 10.1136/bmj.f3359.
  6. NICE. Inhalers for asthma (patient decision aid). 2019. Available at: https://www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patient-decision-aid-pdf-6727144573. A companion patient decision aid user guide is available at: https://www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patient-decision-aid-user-guide-pdf-6727144574
  7. British Thoracic Society. Position Statement: Environment and Lung Health. 2019. Available at: https://www.brit-thoracic.org.uk/document-library/governance-and-policy-documents/position-statements/environment-and-lung-health-position-statement-2019/
  8. Source: Market research survey conducted 27th February - 9th March 2019, by medeConnect Healthcare Insight, among 1,034 adults.
  9. Source: Market research survey conducted 5th – 27th March 2019, by medeConnect Healthcare Insight, among 550 healthcare professionals.
  10. https://www.sduhealth.org.uk/policy-strategy/reporting/nhs-carbon-footprint.aspx
  11. Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag 2019; 15: 461-72.

Initiated, funded and reviewed by GSK. Produced by Markettiers.
Date of preparation: July 2019

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