Green Impact Inhaler Project

Reducing the Carbon Footprint at Redwood Practice through Appropriate Dry Powder Inhaler Prescribing in Asthma

Redwood Practice is committed to helping the NHS reach their target of being totally carbon neutral by 2040¹.

We are currently reviewing our own practices to look for changes we can make to help shape an environmentally friendly and sustainable future by reducing our carbon footprint.

One change that we have identified is converting patients from Metered Dose Inhalers (MDIs) to Dry Powder Inhalers (DPIs) where appropriate.

This conversion is something that the healthcare team here at Redwood Practice feel passionately about. To make a real change we will need the help of our patients.

What are metered dose inhalers and dry powder inhalers?

Metered Dose Inhalers (MDIs) use a pressurised propellant within the aerosol chamber to help administer the medicine. The propellants used in these inhalers are potent greenhouse gases which cause damage to the ozone layer.

Dry Powder Inhalers (DPIs) are newer inhalers, where the medicine is released when the patient breathes in on the inhaler. This means that there is no need for the pressurised propellant.

Why are these inhaler changes important?

Inhalers contribute to roughly 3.5% of the NHS’ total carbon footprint².

As mentioned, MDIs use greenhouse gases as their propellants. This means that, on average, 100 doses of an MDI releases carbon emissions equivalent to that released during a 180-mile drive in a car³. On the other hand, DPIs release 18 times LESS carbon emissions that MDIs⁴.

Climate change is also an important determinant of social and physical health⁵. In other words, reducing climate change will not only have a positive impact on the environment, but it will also improve our health in general.

How will we be implementing these inhaler conversions?

We have identified two groups of patients in which we could make a significant impact.

These are:

1. Asthma patients over the age of 18 currently on the Fostair (MDI) inhaler can be converted to the Fostair NEXThaler (DPI).
2. Asthma patients over the age of 18 currently on any Beclomethasone inhaler (MDI), for example clenil, can be changed to the Beclomethasone Easyhaler (DPI).

We will be sending out text messages to these patients in the near future to gauge their interest in converting to the environmentally friendly DPI inhalers.

We welcome patients interested in changing from an MDI inhaler to a DPI inhaler, to email redwood.practice@nhs.net with subject ‘FAO Clinical Pharmacist’ to register their interest.

Should this intervention prove successful, we will then look to other patient groups on other inhalers to make similar conversions in the future.

How will changing to a DPI affect me?

The medication and dose that you receive will remain same, so it should not have any impact on your health. The only aspect that will change is device that delivers the medication.

Some people find the DPIs are easier to use as they do not require the hand-breath coordination that is required by MDIs⁶. Although some people may find that they prefer their original MDI.

Of course, should you decide that you prefer your original MDI after trying the DPI, you can always be switched straight back.

Inhaler technique

When changing over inhalers it is important that patients know the correct technique for their new inhaler.

Our posters for the Fostair NEXThaler technique and the Beclomethasone Easyhaler technique can be founds below.

Alternatively you can visit the links below which show the correct technique for both inhalers:

Fostair NEXThaler: www.asthma.org.uk/advice/inhaler-videos/nexthaler

Beclomethasone Easyhaler: www.asthma.org.uk/advice/inhaler-videos/easyhaler

1. NHS England. Delivering a ‘Net Zero’ National Health Service. www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf (EXTERNAL PDF LINK).
2. NHS Sustainable Development Unit. Sustainable Development in the Health and Care System: Health Check;2016. www.sduhealth.org.uk/documents/publications/2016/20160310%20SDUupdate%20FINAL%20CR%20update.pdf (EXTERNAL PDF LINK).
3. NICE National Institute for Healthcare and Excellence: asthma patient decision aid. www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patient-decision-aid-pdf-6727144573 (EXTERNAL PDF LINK)
4. British Thoracic Society (BTS) (2019) Position Statement: Environment and Lung Health. www.brit-thoracic.org.uk/document-library/governance-and-policy-documents/position-statements/environment-and-lung-health-position-statement-2019
5. Watts N, Amann M, Arnell A, et al. (2018). The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. Lancet, 392(10163):2479–2514
6. Desai, H. & Dala, B. (2012) Management Options in Chronic Obstructive Pulmonary Disease. Clinical Medicine Insights: Therapeutics. 4(4):273-285.