NCL ICS has made a commitment to improve respiratory care while reducing carbon emissions in accordance with the NCL Green Plan and national Greener NHS plans.

Pressurised Metered Dose Inhalers (pMDIs) account for 3.5 per cent of the entire NHS carbon footprint.

The majority of inhalers prescribed in the UK (around 70 per cent) are pMDIs. These contain propellants called hydrofluorocarbons which are potent greenhouse gases. Dry powder inhalers (DPIs) do NOT use these propellants and have substantially lower global warming potential.

The image below demonstrates the equivalent tailpipe carbon emissions between a Ventolin pMDI and Ventolin DPI. 

Sustainable/lower carbon footprint inhaler options should be chosen where clinically suitable. The information and links to resources on the right hand side can be used to inform clinical decisions to meet targets outlined in the IIF to improve patient care and reduce carbon emissions.

The NCL Joint Formulary Committee has approved inhaler choices for use within NCL.

To reduce the carbon footprint of inhaler prescribing: 

• Optimise asthma care following national guidelines 
• Offer DPIs or SMIs as first choice when clinically appropriate 
• If pMDIs are needed for an individual then choose brand and regime with care to minimise the carbon footprint 
• Ask patients to return all used or unwanted inhalers to community pharmacies or dispensaries for appropriate disposal 

To safely and effectively change inhalers:

• Focus on finding the right medication and device for each individual in consultation with them and their carers, through shared decision making 
• Assess and optimise inhaler technique at every opportunity 
• Follow patients up to ensure suitability of device and disease control 
• Do not undertake blanket switching if changing the device type or medication