Articles
Primary and Secondary Prevention IV Fluids for Neonates Guide to the NIPE UNICEF breastfeeding tool Weight loss guideline (NHS Highland) Criteria for attendance at delivery by Neonatal Staff (GGC link) Managing Inpatient Drug Withdrawal Styroke Thrombectomy Pathway Dysphagia Diagnosis, treatment and management of UTI in children (D&G) Hospital at Home (H@H) Infant hip clinic referral form Vaccination referral form Assessment and management of babies who are accidentally dropped in hospital DGRI NNU Guideline for Management of Cord Blood Gas Results NNU Admission Criteria Antenatal Drugs for NAS Monitoring Vaccination Referrals from ED Paediatric Antimicrobial Guidance Children’s Services Resolution and Escalation Protocol Blunt Chest Wall Trauma/Rib Fractures Information for Parents Carers of Children Having Investigations in Relation to Unexplained Injuries + Consent form Bruising and Injuries in Babies and Children – Parents Leaflet Multi-Agency Protocol for Injuries to Non-Mobile Children Flowchart for children attending Galloway Community Hospital (GCH) for NAI Follow Up Skeletal Survey Flowchart for children attending DGRI for NAI Follow-Up Skeletal Survey Cognitive Function Conscious Level Kidney Biopsy Complications Parenteral Iron for Non-HD CKD Patients Fracture Management Guidelines (Paediatric) Fracture Management Guidelines (Adult) Management of Hypertension in Acute Stroke Prescribing for CAU Patients Still in ED Hypothermia Deactivation of Implantable Cardioverter Defibrillator Myeloma Croup Care Of Burns In Scotland (COBIS) Paediatric Guidance Management of Epistaxis Sore Throat Differential Diagnosis Dizziness Differential Diagnosis Peritonsillar Abscess/Quinsy Acute Tonsillitis Acute Mastoiditis Otitis Media Otitis Externa Extravasation of IV Amiodarone WoS Paediatric Drooling and Aspiration Guideline Palliative Care – How to Refer Eating Disorders Stroke Care Warfarin Anticoagulation for AF, DVT and PE Molnupiravir MyPsych Foundation Doctors Toolkit Paediatric Febrile Neutropenia Guidance PAEDIATRIC HYPOGLYCAEMIA MANAGEMENT in NON DIABETIC CHILDREN   Paediatric Diabetic Ketoacidosis (DKA) Guideline Child Protection Policies and Procedures (D&G) Management of Acute Behavioural Challenges in Adolescents and Young People presenting to Secondary Care Cancer of Unknown Primary Patients Returning from Interventional Cardiac Procedure Treatment of Malaria Discharging Patients on High Dose Steroids Sotrovimab Paediatric Ketone Correction Guideline Insulin Correction Factor Table (Paediatrics) Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s Management of Hypoglycaemia in Children with Type 1 Diabetes Newly diagnosed diabetic – not in DKA (Walking wounded) Proton Pump Inhibitor Guideline for Neonatal and Paediatrics Stroke – Post Thrombolysis Neonatal Guidelines Gentamicin Prescribing (Paediatrics) Management of Anaphylaxis (Paediatrics) Management of Prolonged Seizures (Convulsive Status Epilepticus) in Children Bronchiolitis Acute Wheeze or Asthma in Paediatrics Conscious Proning Covid-19 Basics Remdesivir Thromboprophylaxis Identifying Patients in the Highest Risk Groups Steroids for Patients with Covid-19 Infection IL-6 Inhibitors – Tocilizumab or Sarilumab Baricitinib Paxlovid (Nirmatrelvir/Ritonavir) Influenza A Inhalers for Adults with Asthma Standard Operating Procedure for AMU Trigger Finger/Thumb Osteoarthritis of the Hand/Thumb Mallet Finger Ganglion Dupuytren’s Contracture De Quervain’s Tenosynovitis Carpal Tunnel Syndrome Prescribing Advice on Admission – Clozapine Prescribing Advice on Admission – Methadone/Buprenorphine Prescribing Advice on Admission – Corticosteroids Prescribing Advice on Admission – Items Not Prescribed by GP Prescribing Advice on Admission – Patients on Chemotherapy Regimes Prescribing Advice on Admission – Medication for Parkinson’s Disease Prescribing Advice on Admission – Insulin Prescribing Advice on Admission Medical Emergencies in Eating Disorders (MEED) Gentamicin & Vancomycin HIV Testing Guidelines Metabolic Syndrome Associated Fatty Liver Disease (MAFLD) Greener Inhaler Prescribing C4 Predischarge Beds Handover Safe and Secure Handling of Medicines Blood Glucose & Steroids IV Fentanyl & Morphine for Acute Pain in Adults Assessment & Management of Acute Pain Hospitalised and Has Coronavirus19 Infection (No suspected Viral Pneumonia Syndrome) Hospitalised Due to Coronavirus19 with Likely Viral Pneumonia Bi-Level NIV S/T Guidelines for CCU Phase Bi-Level NIV S/T Guidelines for ED Phase Adults With Incapacity Premenstrual Syndrome Pelvic USS Boarding Coeliac diagnosis pathway (Adults) Voice clinic Ear Wax Dermatology Squamous Cell Carcinoma (SCC) Malignant Melanoma Basal Cell Carcinoma (BCC) Nipple Discharge Early Cancer Diagnostic Clinic (ECDC) Genetics Referrals Breast Infections Breast Pain Primary Care Prescribing Guidelines Emergency Department Anaesthetics and Chronic Pain Team Respiratory Referrals Chronic Cough Pathway GP Clinical Handbook Test Paediatric Bronchiolitis Early Cancer Diagnosis Clinic (ECDC) Obstetrics & Gynaecology/Medicine Admission Agreement Idiopathic Intrancranial Hypertension Urology Out of Hours Urology Out of Hours Sengstaken/Minnesota Tube for Bleeding Varices Eradication of Helicobacter pylori Transfer from Galloway Community Hospital Repatriation of Patients from Tertiary Hospitals THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 1, Risk factors THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 3, Postnatal assessment & management THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 4 THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 2, Management of women with previous VTE THROMBOPROPHYLAXIS IN PREGNANCY, LABOUR AND THE PUERPERIUM Orthopaedic VTE Risk Assessment Sodium Glucose Transporter 2 Inhibitors (SGLT2i) Cardiology Referrals Vascular Referrals ‘Watershed’ Conditions Myasthenia Gravis Gentamicin in Renal Replacement Therapy Vancomycin in Renal Replacement Therapy REDMAP Poster Realistic Conversations Summary Plan for Deteriorating Health Treatment Escalation Plans Ambulatory Care for Blood and/or Iron Infusion Principles for Light Touch Patients – B2 Clostridiodes difficile Infection Post Astra Zeneca Vaccine Headache Blood Culture Rhabdomyolysis Analgesia Acute Appendicitis Small Bowel Obstruction Elective Admission – Colorectal Surgery Trauma Admissions Post-operative Care Gallstone Disease Vasopressors and Inotropes/Chronotropes Shock Elective Admission – ERCP Elective Admission – Orthopaedics Laxatives Fat Embolism Compartment Syndrome Surgical Post-operative Complications Stoma Diverticular Disease High Dose Steroid Pre-Treatment Checklist Acute Surgical Admissions Level 1 CCU Medical Area Acute Oncology STEMI Thrombolysis Protocol Haemolytic Anaemia Conversion Charts Anticipatory ‘As Required’ Medications Syringe Driver Chart Scottish Palliative Care Guidelines Covid-19 Sick Day Rules for Patients with Primary Adrenal Insufficiency Diabetic Retinopathy Dental Abscess Facial Trauma – Mandibular Fractures Facial Trauma – Orbital Fractures Facial Trauma – Zygoma Platelet Transfusion Death Certification Parenteral Iron in Adults >18 Years OPAT SBAR (Complex Infections) Mental Health Liaison Team Referrals STEMI Admitting Patients with Tracheostomy/Laryngectomy to DGRI Emergency Laryngectomy Management Emergency Tracheostomy Management Safe Transfer of Patients with Tracheostomy/Laryngectomy within DGRI Other Tracheostomy Documents Systemic Anticancer Therapy Toxicity Haemodialysis Medication Prescribing Breaking Bad News by Telephone End of Life Diabetes Care Adrenal Insufficiency Serotonin Syndrome DGRI Referrals Confirmation of Death Neuroleptic Malignant Syndrome Pulmonary Embolism Deep Vein Thrombosis of Lower Extremities Exacerbation of COPD Contrast Associated AKI Paracetamol Hypertensive Emergencies Staphylococcus aureus Bacteraemia (SAB) Rate Control in AF Common Scenarios Acute Severe Ulcerative Colitis IV Fluid Prescription in Adults Chronic Obstructive Pulmonary Disease Legionnaires Disease Septic Arthritis Guillain-Barré Syndrome Back Pain Anaesthetics – Unscheduled Procedures Requests Hyperglycaemia & Steroids Variable Rate Insulin Infusion Decompensated Liver Disease Fast Atrial Fibrillation – ACP Hyperkalaemia Contraindications to MRI Magnetic Resonance Imaging Bleeding with Other Antithrombotics In-patient Hyperglycaemia Management Anaemia (Management) – ACP Suspected NSTEMI – ACP Guidance on Chaperones Compulsory Admission and Treatment Radiology Immediate Discharge Letter Alcohol Withdrawal Fentanyl Patches in the Last Days of Life Care in the Last Days of Life Low Molecular Weight Heparin Interstitial Lung Disease Haematinic Testing Thromboprophylaxis for Non-Covid Patients Lung Cancer Osteoporosis Heart Failure Fluid Replacement in AKI Death & The Procurator Fiscal Thrombophilia Screening Neutropenic Sepsis Acute Vertigo Aortic Dissection Antithrombotics in Hip Fracture Transient Global Amnesia Hypomagnesaemia Hypophosphataemia Oxygen Therapy Falls – ACP Falls Acute Asthma Oncology Contact Details & General Advice Reversal of Warfarin Lumbar Puncture, Antiplatelet & Anticoagulant Drugs Antithrombotics & Surgery Non ST Elevation MI (NSTEMI) Suspected Acute Coronary Syndrome Antibiotics and the Kidney Acute Upper GI Bleeding (AUGIB) Pericardiocentesis Pleural Effusion Spontaneous Pneumothorax Acute Diarrhoea Iron Deficiency Anaemia Hyperthyroidism Gout Giant Cell Arteritis Pacemakers Clinical Suspicion PE – ACP Community Acquired Pneumonia (CAP) Management of Urinary Symptoms Acute Kidney Injury (AKI) SSRI Poisoning Immobility Autopsies Indications for Echocardiography Bradycardia Suspected Meningitis Hypernatraemia Diarrhoea – ACP Suspected Meningitis – ACP Blood Transfusion Brain Tumours Newer Antidiabetic Drugs Parkinson’s Disease Major Haemorrhage Protocols (DGRI & GCH) Major Haemorrhage Stroke Thrombolysis Pneumothorax – ACP Heart Failure – ACP Suspected Anaphylaxis Anaphylaxis – ACP The AMB Score – ACP Transient Loss of Consciousness (TLOC) – ACP Bell’s Palsy – ACP Suspected Sepsis Lumbar Puncture Hypokalaemia Gentamicin Dosing Transient Loss of Consciousness Urinary Tract Infection Urethral Catheterisation Vancomycin Dosing Hyponatraemia Narrow Complex Tachycardia Hypocalcaemia New Onset Type 1 Diabetes – ACP Paracentesis for Tense Ascites – ACP Idiopathic Intracranial Hypertension – ACP Other Funny Turns Hypoglycaemia Hypoglycaemia – ACP Management of Transfusion Reactions Hypercalcaemia Haematemesis – ACP Anti-Platelet Therapy in Coronary Heart Disease Unfractionated Heparin Infusion Anaemia (Investigation) – ACP Delirium Suspected Seizure – ACP Headache – ACP Community Acquired Pneumonia – ACP Cellulitis Dyspepsia Management of Acute AF Rhythm Control in AF Atrial Fibrillation Kidney Transplantation Massive Pulmonary Embolism Head and Neck Injury Diabetic Ketoacidosis Switching from VRII Insulin Pumps Diabetes Mellitus Aspirin Digoxin Poisoning Tricyclic Antidepressants Opiates Benzodiazepines Gut Decontamination Deliberate Self Harm Acute Liver Failure Asymptomatic Raised Transaminases (ALT & AST) Nutritional Support in Adults Refeeding Syndrome Parenteral Nutrition Crohn’s Disease Acute Pancreatitis Abdominal Aortic Aneurysms Malignant Spinal Cord Compression Post Splenectomy Sepsis Ascites in Cirrhosis Alcohol Related Liver Disease Hepatitis C Symptom Control Suspected Variceal Bleeding Severe Headache Status Epilepsy in Adults Lower Gastrointestinal Bleeding Functional & Social Assessment Breathlessness with Abnormal CXR Polymyalgia Rheumatica Rheumatoid Arthritis Ureteric Colic & Renal Stones Intravascular Catheter Related Blood Stream Infection Care of Vascular Access Urinary Incontinence Peritoneal Dialysis Related Peritonitis The First Seizure Hypertension Ventricular Tachycardia Cardiogenic Shock Complicating Acute Coronary Syndrome Telemetry The Diabetic Foot Subcutaneous Insulin Diabetes and Acute Coronary Syndrome Hyperosmolar Hyperglycaemic State Multiple Sclerosis Coma
 
Close Menu
 
 
In this section Close
In this section : Respiratory : Safe and Effective Use of Medicines
Prescribing for CAU Patients Still in ED Prescribing Advice on Admission – Clozapine Prescribing Advice on Admission – Methadone/Buprenorphine Prescribing Advice on Admission – Corticosteroids Prescribing Advice on Admission – Items Not Prescribed by GP Prescribing Advice on Admission – Patients on Chemotherapy Regimes Prescribing Advice on Admission – Medication for Parkinson’s Disease Prescribing Advice on Admission – Insulin Prescribing Advice on Admission Gentamicin & Vancomycin Greener Inhaler Prescribing Safe and Secure Handling of Medicines Blood Glucose & Steroids
Home | Articles | Respiratory | Greener Inhaler Prescribing

Greener Inhaler Prescribing

Last updated 14th December 2022

The research on this topic applies most to adults with asthma. Some points may be generalisable to adults with COPD but discuss with Respiratory Specialist Nursing Team or your pharmacist if unsure.

 

Background

The NHS contributes around 6.1 mega-tonnes of CO2e towards UK greenhouse gas emissions, about 4% of the UK total. 3% of NHS greenhouse gas emissions come from inhaler prescribing1.

Environmental issues surrounding inhaler prescribing include lack of recycling facilities for inhalers and medication wasted due to ineffective technique, but the most significant contributor to emissions is the greenhouse gas effects of propellants used in metered dose (MDI) inhalers. This includes pressurised MDIs (pMDIs) and breath-actuated inhalers (BAIs). Dry powder (DPI) and soft mist (SMI) inhalers do not use these propellants and subsequently have a much smaller carbon footprint than MDIs.

Principles of Environmentally Friendly Inhaler Prescribing

  1. The use of rescue medication (SABA inhalers i.e. salbutamol) makes up 70% of inhalers used2, therefore the greenest way to prescribe inhalers is by taking a patient-centred approach which seeks to optimise asthma control and reduce the need for rescue medication. If a patient is well controlled with their current regime and device, it is not advisable to change it.
  2. If you prescribe salbutamol generically, the patient could be given anything from a Salbutamol Easyhaler, a DPI with a low carbon footprint, to Salbutamol CFC-free or Salamol, which are reasonably environmentally friendly MDIs, to Ventolin, a non-Formulary MDI which is very bad for the environment. When prescribing, prescribe by specific brand.
  3. It is a myth that DPIs are more difficult to use – in a small audit of asthma inhaler technique at DGRI, patients demonstrated perfect technique more often with DPIs than they did MDIs. MDIs require more coordination to deliver the drug properly than DPIs.Asthma & Lung UK have a resource of videos on how to use the various inhalers correctly.
  4. DPIs require patients to be able to take a short, fast inhalation and this has led to concerns by some that they are inappropriate for frailer patients. The only reliable test for whether your patient can use a DPI is by using a training device such as InCheck – speak to the Respiratory Specialist Nursing Team about this.
  5. Some are concerned that DPIs may be inadequate to deliver rescue medication when a patient is having acute symptoms. At present this is an evidence-free zone and it is important to bear in mind that DPIs are significantly better at drug delivery than using an MDI without a spacer3.
  6. The presence of a dose counter on an inhaler can reduce waste as it gives patients a guide to when they need to replace their inhaler. Many SABA and MDI inhalers do not have a dose counter.
  7. If your patient is on multiple inhalers, are they all the same type, or different? If a patient is on an MDI and a DPI, chances are they might thank you for switching them to two DPIs, bearing in mind points (1) and (4).
  8. At present there is no way of recycling spent inhalers4 so it is worth bearing in mind that a medication with a one puff once daily regime will use roughly four times less plastic and contribute less to landfill than a medication which is required two puffs twice daily. If you are increasing the dose of a particular inhaler for your patient, is there a stronger dose inhaler you could use? i.e. Budesonide Easyhaler 200microgram/dose TWO puffs TWICE daily has twice the carbon footprint of Budesonide Easyhaler 400microgram/dose ONE puff TWICE daily. It is likely your patient will have better compliance with an inhaler they need to replace less often too.
  9. For asthma patients, the Maintenance and Reliever Therapy (MART) regime is a regime that advocates that patients use one formoterol-containing combination inhaler both as a maintenance treatment and during exacerbations. It reduces the need for several inhalers and may improve asthma control, as patients receive the anti-inflammatory benefits of some inhaled steroid even during an exacerbation. This will become best practice for asthma prescribing in the next iteration of the BTS/SIGN guidelines, due in 2023. Discuss with the Respiratory Specialist Nursing Team if you think this may be suitable for your patient.
  10. NICE has provided an excellent patient decision aid for use when choosing and changing inhalers. This includes environmental considerations.
  11. Click the following link for videos on how to use the various inhalers correctly from Asthma.org.uk

Are Environmentally Friendy Inhalers More Expensive?

As the following table demonstrates, cheaper inhalers are not necesarily worse for the environment (though the opposite is sometimes true!).

CARBON FOOTPRINT AND FINANCIAL COST OF INHALERS USED IN ASTHMA
GREEN: Carbon footprint per inhaler <2 kgCO2e, use if clinically indicated
AMBER: Carbon footprint per inhaler 6-20 kgCO2e, use if lower carbon footprint inhaler unsuitable
RED: Carbon footprint per inhaler >34 kgCO2e, avoid using unless absolutely necessary
All table data from the Greener Practice Inhaler Prescribing Guideline and BNF

All devices featured in MDI and DPI/SMI columns are part of the NHS D&G Formulary April 2022
Cost/carbon footprint are given per month of inhaler use with exception of SABA inhalers which are given in cost/carbon footprint per inhaler
Use in conjunction with relevant treatment guidelines:
TG1 BTS/SIGN Asthma Treatment Guideline 2019 [pdf]
TG2 GINA 2022 asthma guideline (page 56 of Full Report features quick treatment algorithm for adults. BTS/SIGN guidance due to be brought in line with this in 2023)
TG3 NICE COPD in over 16s treatment algorithm
MDIDPI/SMINotes
SABA TG1 TG3

SALBUTAMOL CFC-FREE
12kg CO2e/inhaler
£1.50


SALAMOL
EASI-BREATHE (BAI)
12kg CO2e/inhaler
£6.30


SALBUTAMOL EASYHALER 100 & 200
0.6kg CO2e/inhaler
£3.31 and £6.63


This inhaler is non-formulary and should NOT be prescribed unless there is no other suitable option:

VENTOLIN EVOHALER
*(non-formulary)*
25.3kg CO2e/inhaler
£1.50


SAMA TG3

IPRATROPIUM BROMIDE CFC-FREE (ie ATROVENT)
One Puff FOUR TIMES DAILY
8.8kgCO2e/inhaler £3.33
----------
Two puffs FOUR TIMES DAILY
17.6kgCO2e/inhaler £6.66
LAMA TG1 TG2

SPIRIVA RESPIMAT (SMI)
TWO puffs ONCE daily
0.8kgCO2e/inhaler
£23.00
(if device used once)5
----------
0.2kgCO2e/inhaler
£23.00
(if one device refilled
6 times)5


Spiriva Respimat (tiotropium) is accepted for use in Scotland as an add-on maintenance bronchodilator in adults with asthma treated with a maintenance combination of medium dose ICS+LABA who experienced >1 severe exacerbations in the past year.
LABA+ICS Doses, costs and carbon footprints listed for
low TG1 TG2
medium TG1 TG2
high TG1 TG2 and/or
MART TG2 regimes.

Formulary inhalers marked F contain formoterol and are recommended as first-line as PRN inhalers as per GINA guideline, or as part of MART Regime

F LUFORBEC 100/6
ONE puff TWICE daily (LO)
5.6kg CO2e/month
£20.52
----------
TWO puffs TWICE daily plus FOUR puffs PRN (MART)
up to 22.4kg CO2e/month
up to £41.04


F FOSTAIR 100/6
ONE puff twice daily (LO)
5.6kg CO2e/month
£14.66
----------
TWO puffs twice daily (MED)
11.2kg CO2e/month up to £29.32



FOSTAIR 200/6
(asthma only)
TWO puffs TWICE daily (HI)
14.2kgCO2e/month
up to £29.32


F FOBUMIX EASYHALER
80/4.5
ONE or TWO puffs TWICE daily (LO) 0.2-0.4kgCO2e/month
£10.75-21.50
----------
160/4.5
ONE puff TWICE daily (LO)
0.2kgCO2e/month
£10.75
TWO puffs TWICE daily plus FOUR puffs PRN (MART)
up to 0.8kgCO2e/month
up to £43.00
----------
320/9
TWO puffs TWICE daily (HI)
0.4kgCO2e/month
£21.50


F DUORESP SPIROMAX
200/6
ONE puff TWICE daily (LO)
0.4kgCO2e/month
£13.98
----------
TWO puffs TWICE daily (MED)
0.8kgCO2e/month
£27.96
----------
400/12
ONE puff TWICE daily (MED)
0.4kgCO2e/month
£13.98
----------
TWO puffs TWICE daily (HI)
0.8kgCO2e/month
£27.96




F FOSTAIR NEXTHALER
100/6
ONE puff TWICE daily (LO)
0.4kgCO2e/month
£14.66
----------
TWO puffs TWICE daily (MED)
0.8kgCO2e/month
£29.32


These inhalers are both non-Formulary and should NOT be prescribed unless there is no other suitable option:

SYMBICORT pMDI
100/3 and 200/6
*(Non-Formulary)*
ONE to TWO puffs TWICE daily (LO)
18-35kg CO2e/month
£7 and £14


FLUTIFORM 125 pMDI
*(Non-Formulary)*
TWO puffs TWICE daily
35kg CO2e/month
£28.00
ICS (Low Dose) TG1 TG2

SOPROBEC 200micrograms
ONE puff twice daily
5kg CO2e/month
£3.63


KELHALE 100micrograms
ONE puff twice daily
5.2kg CO2e/month
£1.56


BECLOMETASONE EASYHALER 200micrograms
ONE puff TWICE daily 0.2kgCO2e/month
£4.48


BUDESONIDE EASYHALER 200micrograms
ONE puff TWICE daily
0.2kgCO2e/month
£5.31
ICS (Medium Dose) TG1

SOPROBEC 200micrograms
TWO puffs twice daily
10kg CO2e/month
£7.26


KELHALE 100micrograms
TWO puffs twice daily
10.4kg CO2e/month
£3.12


BECLOMETASONE EASYHALER 200micrograms
TWO puffs TWICE daily
0.2kgCO2e/month
£8.98


BUDESONIDE EASYHALER 400micrograms
ONE puff TWICE daily
0.2kgCO2e/month
£5.31
ICS (High Dose) TG1

SOPROBEC 250micrograms
ONE to TWO puffs FOUR TIMES daily
10-20kg CO2e/month
£7.26-14.52


KELHALE 100micrograms
TWO puffs FOUR TIMES daily
20.8kg CO2e/month
£6.24


BECLOMETASONE EASYHALER 200micrograms
TWO puffs FOUR TIME daily
0.8kgCO2e/month
£17.96


BECLOMETASONE EASYHALER 400micrograms
TWO puffs TWICE daily
0.4kgCO2e/month
£10.62
LABA+LAMA TG3

ANORO ELLIPTA
ONE puff ONCE daily 0.7kgCO2e/month
£32.50


SPIOLTO RESPIMAT
TWO puffs ONCE daily
0.8kgCO2e/month
£32.50
(if device used once)4
----------
0.2kgCO2e/month
£32.50
(if device refilled 6 times)4
ICS+LABA+LAMA TG3

TRIMBOW 87/5/9
TWO puffs TWICE daily
14.2kg CO2e/month
£44.50


TRIMBOW NEXTHALER 88/5/9
TWO puffs TWICE daily 0.9kgCO2e/month
£44.5


TRELEGY ELLIPTA 100/62.5/25
ONE puff ONCE daily
0.8kgCO2e/month
£44.5

References

  1. Delivering a ‘Net Zero’ National Health Service
  2. How to Reduce the Carbon Footprint of Inhaler Prescribing – A Guide for Healthcare Professionals in the UK (Asthma UK & British Lung Foundation)
  3. Spacers also have a carbon cost, and this is greater for Volumatic than AeroChamber devices. Spacers cannot be recycled. If prescribing a pMDI however, use of a spacer is essential for adequate drug delivery.
  4. This may change, so it’s important to encourage patients to return their used inhalers to the pharmacy.
  5. According to manufacturer instructions, a Respimat inhaler can be refilled with cartridges up to 6 times before a new device is recommended.

Links

  1. NHSD&G Guidance on Inhalers for Adults with Asthma
  2. NICE Patient Decision Aid – Inhalers for Asthma
  3. BTS/SIGN asthma treatment algorithm 2019
  4. GINA 2022 Asthma Guideline (page 56 of Full Report features quick treatment algorithm for adults)
  5. SIGN/NICE Visual Summary Algorithm COPD Treatment in Adults
  6. Greener Inhaler Prescribing Guideline
  7. Asthma & Lung UK: videos on inhaler technique

Content by Dr Katie Percvial