Primary care professionals have contributed a huge amount of work towards towards reducing the carbon footprint associated with inhalers in north central London over the past year. Huge credit to primary care teams is due for assisting in achieving the national target that was set for this year early. There’s always more that can be done, and there are some suggestions for further progress at the end of this update.

Background

Inhaler emissions account for approximately 3% of the NHS carbon footprint, with metered dose inhaler (pMDI) propellants being responsible for the majority of this. The NHS long-term aim is progress towards 50% reduction in inhaler emissions by 2028, from a 2019/2020 baseline. This averages to approximately 6-7% reduction every year. 

Locally carbon reduction from inhalers is a focus in the NCL Green Plan 2022-2025. A cross-sector, multi-disciplinary sustainable inhaler group formed in July 2022 and was tasked with formulating a workplan to deliver the national and NCL goals. The group monitors delivery and reports to the Greener NCL Board. 

Primary care has been the main focus for the workplan as most inhalers are prescribed in that sector (approx. 92%).

NCL achieved the 2023/24 target of 25% reduction in carbon emissions (from a 2019/20 baseline). See image below:

• Overall aim highlighted in yellow
• Drivers to meet this aim, highlighted in blue. 

(*saba= Short acting beta-agonists e.g. salbutamol)

The ICB would like to thank all clinical teams in NCL who supported delivery of the 2023/24 inhaler carbon reduction targets, through their patient reviews. 

All ICSs have been asked to continue delivering a 6-7% p.a. reduction in carbon emissions from inhalers until the longer-term 50% reduction target is achieved, in 2028. 

Adding these steps when reviewing respiratory patients will support NCL with achieving their future inhaler sustainability goals:   

• Consider a dry powder inhaler instead of a pMDI, where clinically appropriate.
• Where a pMDI is appropriate, consider the lower carbon preparation (e.g. Salamol when salbutamol is needed).
• Consider calling in patients with poor respiratory management for a review. Patients who request more than six reliever inhalers per year are likely to have poor management, for example. 
• Review patients in line with NCL guidance and choose NCL preferred inhalers in the first instance.

Tools and support for practices

• PQS 2024/25: two respiratory indicators are included, one around increasing triple inhaler prescribing and the other focusing on lower carbon footprint options of salbutamol and beclomethasone inhalers
• NCL asthma and COPD guidelines. Please note that there is a traffic light system for inhalers in the guidelines. Consider more sustainable inhalers, highlighted in green, when reviewing your patients. 
• EMIS searches to proactively identify patients for review with possible poor management of their condition (ask the ICB medicines optimisation team for more details).
• Education and training (ask the ICB medicines optimisation team for more details)
• ScriptSwitch messages to highlight preferred NCL inhalers and lower carbon footprint options
• AccuRx messages to support communication with patients around changes to inhaler prescriptions
• Dedicated page to lower carbon inhalers with linked resources to support primary care clinical staff and optimising prescribing

Your continued support with this work is appreciated. 

In addition to this work, an inhaler recycling programme is being explored.