Please note this project has now completed. The information on this page was accurate on closure of the project but will not be updated further. If you have any questions please contact opportunities@healthinnovationwm.org

This project completed in March 2024

About the project

Medicines, including inhalers, contribute significantly to the environmental impact of the NHS. Medicines account for 25% of the NHS carbon footprint with 3% of this attributed to inhalers, predominantly metered dose inhalers (MDI’S) which contain harmful greenhouse gases as propellantsⁱ. Dry powder and soft mist inhalers offer alternatives that are less harmful to the environment, which most patients are able to useⁱⁱ.

Alongside the environmental impact of inhalers, patients in the UK experience poorer outcomes in terms of respiratory disease in contrast to comparable countriesⁱⁱⁱ. Overuse of short acting beta agonists (SABA), such as salbutamol and terbutaline, have been highlighted as a key risk factor for poor disease control and the UK has a higher rate of SABA overuse than other European countries with an associated increased risk of exacerbations and mortality^iv. Salbutamol MDI are currently the biggest source of carbon emissions from all NHS prescribing^v.

References:  

ⁱ NHS, Delivering a Net Zero National Health Service NHS Carbon footprint plus from https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf

ⁱⁱ National Institute of Health and Clinical Excellence. NG80 Asthma inhalers and the environment decision aid. NG80 Asthma inhalers and the environment patient decision aid (nice.org.uk)

ⁱⁱⁱ National Review of Asthma Deaths Why asthma still kills Why asthma still kills 11 August 2015 Why asthma still kills | RCP London

^iv Janson C, Menzies-Gow A, Nan C, Nuevo J, Papi A, Quint JK, Quirce S, Vogelmeier CF. SABINA: An Overview of Short-Acting β₂-Agonist Use in Asthma in European Countries. Adv Ther. 2020 Mar;37(3):1124-1135. doi: 10.1007/s12325-020-01233-0. Epub 2020 Jan 24. PMID: 31981105; PMCID: PMC7089727.

^v Network Contract Directed Enhanced Service Investment and Impact Fund 2022/23: Updated Guidance March 2022 https://www.england.nhs.uk/wp-content/uploads/2022/03/B1357-investment-and-impact-fund-2022-23-updated-guidance-march-2022.pdf

Project ambitions

Health Innovation West Midlands has developed this Toolkit, aimed at both primary and secondary care which summarises resources and quality improvement projects available to improve respiratory prescribing alongside the impact of inhaler prescribing on the environment.

The toolkit covers areas such as how to:

• Reduce reliance on short acting beta agonist inhalers (Reliever inhalers)
• Increase the use of Inhaled Corticosteroid Inhalers (Preventer/treatment inhalers)
• Increase use of inhalers that have a greener footprint
• Improve outcomes for patients with respiratory disease
• Reduce the environmental impact and carbon emissions of inhalers

For further information or for copies of the toolkit for local adaptation please contact anna.edwards@healthinnovationwm.org

The Toolkit was developed to enable wider spread within the West Midlands of Sustainable Respiratory information as a result of successful work undertaken in 2022-2023 with Herefordshire and Worcestershire ICS: Improving environmental sustainability and asthma care. Healthier Futures- Greener NHS.

Health Innovation West Midlands supported a successful NHS Healthier Futures bid with Alastair Jackson of Wyre Forest Health Partnership and Herefordshire and Worcestershire ICS.

This series of four online meetings supported practices in delivering the respiratory and sustainability elements of the investment and impact fund safely and effectively whilst at the same time improving asthma care. Alongside the further goal of providing information about sustainability in primary care and how we can move towards the NHS’s Net Zero goals.