As part of our commitment to keeping you up to date with news affecting pharmacists, we at MORPh have started to cover the NHS green agenda in some of our pharmacist training webinars. This blog post covers the basics of the NHS commitment to lowering carbon emissions. We look at low carbon inhalers and patient considerations as well as the impact of inhalers on the environment.
NHS commitment to lowering carbon emissions
Through its long term plan, the National Health Service has committed to reduce its use of natural resources in line with government commitments. Since 2007, the carbon footprint of health and social care has reduced by 19%, despite a 27% increase in activity. Irrespective of this reduction, there remains a significant challenge to deliver the Climate Change Act target of a 51% reduction by 2025. Shifting to low carbon inhalers will deliver a reduction of 4%. A further 2% will be delivered by transforming anaesthetic practices. Adherence to best practice efficiency standards and adoption of new innovations in all trusts will further reduce carbon as well as water and waste. The key is delivery of improvements including reductions in use of single-use plastics throughout the supply chain.
Low Carbon Inhalers
Hydrofluorocarbons (HFCs) are used in pressurised Metered Dose Inhalers (pMDIs) as a propellant to deliver medicine from inhaler to patient. HFCs are powerful greenhouse gases whose effect on climate change is up to 3800 times more powerful than carbon dioxide. During 2018, HFCs were thought to be responsible for around 4% of the entire carbon footprint of the NHS. A total of 850,000 tonnes of CO2 emissions. This figure exceeds the total carbon footprint of some small nations.
Around 70% of inhalers used in the UK are pMDIs. In Europe, less than 50% of inhalers are pMDIs and in Scandinavia that figure reduces to 10-30%. This variation in numbers indicates that there are clinically appropriate ways to reduce the level of pMDI devices prescribed in the UK.
Combining correct inhaler technique with the right inhaler is invaluable to a patient
Reducing the carbon impact of inhalers
The NHS has committed to reducing the carbon impact of inhalers used to treat respiratory conditions by 50%. When Structured Medication Reviews or planned Asthma Reviews are conducted in primary care, practitioners should consider moving or facilitating patients to low carbon inhalers where clinically appropriate.
All inhalers should be returned to a pharmacy for recycling. If that pharmacy has no recycling scheme, they should be placed in the normal pharmaceutical waste bins. Even when used, pMDI cannisters still contain propellants. These are powerful greenhouse gases which contribute to global warming and should be disposed of in an environmentally safe way.
Each year, 73 million respiratory inhalers are prescribed in the UK. The carbon emissions from these are potentially equivalent to that produced by over 300,000 cars. If every UK inhaler user returned all their inhalers for recycling for a year, 512,330 tonnes of carbon dioxide could be saved.
Low carbon inhalers: Risk to the environment vs risk to the patient
Whilst recycling is one key aspect of the green healthcare agenda, the whole patient journey has an environmental impact. There is a large focus on low carbon inhalers but switching to DPI or Soft Mist is not always the best option for the patient.
- Inaccurate diagnosis could result in repeated unnecessary healthcare appointments with symptoms remaining unresolved
- Repeated appointments for tests performed at different times
- Prescribing for an inaccurate diagnosis causes unnecessary transportation of medication, side effects for patients and waste from unnecessary inhalers
Reasons why a dry powder inhaler (DPI) might not be suitable:
- Some inhalers are only available in an MDI form
- Some patients such as those with low inspiratory flow rate may not be able to effectively use dry powder inhalers so it is not clinically appropriate to switch
- Depending on the HFC used, some MDIs have greater global warming potential (GWP) than others – even if there is no DPI alternative, there may be an MDI alternative with a lower GWP
- Most areas have a local formulary and their recommendations are based on evidence, cost and available local services
- The patient may be stable on their existing treatment and intervention could risk destabilising them
- The least environmentally friendly inhaler is the one a patient can’t or won’t use
To learn more about inhaler use and the environmental agenda, head to our list of FREE pharmacist training webinars. Our members’ only educational platform is also free to join and contains a variety of on-demand webinar training.
