Optimising asthma care and greener inhaler prescribing

High-quality asthma care involves ensuring concordance with inhaled corticosteroids, whilst minimising the use of Short Acting Beta Agonists (SABAs). In addition, the UK Government has committed to cutting the UK's greenhouse gas emissions by 78% of 1990 levels by 2035 and achieving net zero by 2050. Inhalers make up 3% of all NHS carbon emissions. According to the National Institute of Health and Care Excellence (NICE), metered dose inhalers (MDIs) have estimated carbon footprints of 500 g per dose, whereas dry powder inhalers (DPIs) have much lower estimated carbon footprints of 20 g CO2eq per dose. For comparison, estimated carbon footprints indicate that a 9 mile trip in a typical car produces 2610 g CO2eq (or 290 g CO2eq per mile) (Prescqipp, 2022). MDI use in the UK is far higher than in other European countries.

Overreliance on short-acting bronchodilators (SABA) can indicate poor disease control. Three or more days a week with any need for SABA is a pragmatic threshold for uncontrolled asthma (NICE, 2017). Well-controlled asthma for most patients will mean using how many SABA inhalers a year?