Inhalers are some of the most commonly prescribed medicines in the UK and can be expensive. They form the mainstay of treatment for asthma and COPD. They comprise either a pressurised metred dose inhaler (pMDI) or a dry powder inhaler (DPI). Despite global legislation some years ago that removed chlorofluorocarbons (CFCs) from inhalers (Montreal Protocol) due to their harmful effect on the ozone layer; there remains a large difference in the carbon footprint between pMDIs and DPIs. pMDIs have a higher carbon footprint than DPIs and contribute substantially to global warming. The effects of this are to be seen in everyday life and it is the responsibility of all individuals to 'reduce their carbon footprint'.
The environmental impact of inhaler use also comes from plastic waste from discarded inhalers. Over 50 million inhalers are prescribed in the UK each year1, and most of these will end up in landfill sites where they take centuries to biodegrade. There are an increasing number of schemes to recycle inhalers and local pharmacies will often provide these facilities, but this is not routinely advertised to patients.
Current guidelines recommend that where either a pMDI or DPI will be equally as good for the patient then the environmental impact of the inhaler should be considered. TheNational Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. Their guidance includes an algorithm to choose the best inhaler for a patient. Whilst this is helpful on an individual patient basis, there is currently no legislation that mandates the use of DPIs in preference to pMDIs.
The study hypothesises that if Health Care Professionals (HCPs) are provided with the information on the carbon footprint of each inhaler, this may influence the type of inhaler they recommend, i.e., with all things being equal they may show a preference for low carbon DPIs over high carbon pMDIs because of concerns over global warming.
A simple online study has been designed to test whether HCPs, if given information regarding the environmental impact of inhalers, as part of an asthma treatment guideline, are more or less likely to recommend a low carbon inhaler. By better understanding how the inclusion of carbon data influences inhaler prescription choice, we will be able to clarify whether the inclusion of carbon data in asthma treatment guidelines is likely to be beneficial in facilitating a drive to greener inhaler prescribing practices.
