Sustainable Inhaler Prescribing Programme

Sustainable Inhaler Prescribing Programme is reducing NHS Wales’ carbon footprint by improving the type of inhaler therapy.

45,000 t
Est. annual reduction in carbon
emissions (tonnes CO2 eq)

Wales has amongst the highest prevalence of asthma in Europe

Our story

by Dr Simon Barry, Clinical Lead, Respiratory Health Implementation Group Wales

Improving the respiratory health of the population is a major challenge for the NHS in Wales. We have amongst the highest prevalence of asthma in Europe, with nearly a quarter of a million people being treated for the condition, including approximately 59,000 children. The Respiratory Health Implementation Group (RHIG) was established in 2014 to support the development and strategic direction for primary, community, and secondary care respiratory services in Wales.

More recently, we have developed a strategic response with regards to the climate impact of inhaler therapy.

The most commonly used inhaler types for patients with both asthma and COPD are metered-dose inhalers (MDIs) which contain liquified and compressed hydrofluorocarbons (HFCs) gases. HFCs are potent greenhouse gases and contribute significantly to global warming and climate change, amounting to 3.5% of the total carbon footprint of the NHS. In Wales, this equates to 65,000 tonnes of CO2-equivalent each year. In the UK, approximately 70% of inhalers used are MDIs, whereas in Sweden it is only 14%.

That is why we have created the NHS Wales Green Agenda Programme, to reduce the percentage of these types of MDIs prescribed from 70% to 20% by 2025. Working in partnership with the Institute for Clinical Science and Technology (ICST), we have created a number of innovations. These include guidelines which address the climate impact of different inhaler types, national educational programmes for healthcare professionals, patient facing apps (asthmahub and COPDhub), as well as a suite of patient facing communication modalities from posters, social media campaigns, and videos for GP surgeries. In parallel with these innovations is a strategic implementation plan underpinned by the principles of implementation science coordinated by ICST.

Our advice

Digital innovation is key to the successful implementation of innovation campaigns at a national level, as is clear and efficient communication that needs to be adapted for a range of individuals and groups – from patients to healthcare settings.

This programme launched formally in December 2021, at an event which was attended by over two hundred healthcare professionals from across Wales, with the event recording being watched by many hundreds more. During the same week, a free interactive session was held for asthma patients, using the NHS Wales Healthub apps. This session focused on how people living with asthma and COPD can tackle the climate crisis by safely considering a switch to inhalers that are better for the environment.

Print and post packs of updated guidelines and leaflets have been sent to each GP practice across Wales and a digital resource pack has been created for primary care teams, including slide-decks, email and text templates for local communications, digital posters, and animations for waiting room digital screens.

Governance is also a key aspect of creating a successful innovation; it is the framework of authority that ensures that the innovation remains up-to-date and relevant. If new research emerges or the environment changes, the governance process should identify it quickly and adapt and make changes.

Our metrics

The implementation team meet regularly to review the programme, reviewing areas such as the readiness and capacity of patients to make changes, and looking at alignment of the stakeholders who have influence in the system to ensure they understand the value of the programme. The team also currently gets data on real time inhaler prescribing data to monitor the impact on the innovation of the proportion of MDIs that are prescribed, compared to dry powdered inhalers (DPIs).
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