By Anna Murphy
Inhalers are essential for people with conditions like asthma and COPD, but they’re also major polluters of the planet. Metered dose inhalers (MDI) use a propellant gas which contributes an estimated 3% of the carbon footprint of the NHS in the UK. But there are alternatives and many patients are now being offered different inhalers to manage their condition which have far less environmental impact. These are known as dry powder inhalers (DPIs).
How can pharmacists help them make this switch safely?
Each MDI has an estimated carbon footprint of 500g of CO2eq per dose, compared to 20g in DPIs. Yet the way inhalers are prescribed to improve respiratory health varies dramatically between countries. For example, in the UK, around 70% of people are prescribed an MDI, yet in Sweden 90% of people are prescribed a DPI.
There’s now a move in England and Wales to switch patients to using a DPI to manage their condition. Not every patient will be able to use or want to use a DPI, but pharmacists can play a big role in helping the majority understand that DPIs are a safe and effective way of preventing problems and improving their breathing.
Helping you decide
Pharmacists can discuss the choice of inhalers with patients and carers, as well as educating the wider healthcare team on choosing inhalers with less environmental impact. The National Institute for Health and Care Excellence’s Asthma Patient Decision Aid may be helpful in discussions with patients.
If inhalers are prescribed, it’s important that patients are shown how to use them correctly and that regular checks on inhaler technique and adherence with inhalers occurs. From this month, the Pharmacy Quality Scheme in England has a specific criteria related to checking inhaler technique as part of the New Medicine Service and encouraging return of inhalers for disposal.
From my own experience, some people are keen to switch, whilst others need greater reassurance. On learning that inhalers cause damage to the environment, some people fear the inhaler will have damaged them too, which is not the case, but may worry them unnecessarily. A conversation that allows them to voice all their concerns is vital to creating understanding of their condition and their inhaler. People still often don’t use the best technique, so a review is a great opportunity to both allay fears and improve respiratory health. I always direct patients to the excellent ‘how to use your inhaler’ videos from Asthma UK.
Disposal and recycling
The other area that needs to be considered in terms of environmental impact is the disposal and recycling of inhalers. I’m delighted to be involved in a pilot scheme for recycling inhalers which is currently on-going in my own area of Leicestershire.
In spring this year, the Leicestershire Take Air (take Action for Recycling) pilot scheme was initiated by Chiesi Limited, a pharmaceutical company, supported by the University Hospitals Leicester NHS Trust and Leicestershire and Rutland Pharmaceutical Committee. The pilot allows people to recycle any brand or type of inhalers by posting them using a pre-paid envelope, which takes up to four inhalers, so avoiding people disposing of their inhalers in domestic waste. If there is any propellant gas remaining in the cannister, it is extracted and reused in items such as fridges and air conditioning units. The aluminium cannisters are recycled and reused, whereas the plastic is recycled. If there are any non-recyclable materials they will be converted into energy (energy from waste scheme). The scheme complements the waste collection service already available within community pharmacies and is particularly useful for those housebound patients or patients who have home deliveries and so do not visit in person the pharmacy. The scheme lasts for a year and will be evaluated and rolled out if successful.
We need a collaborative approach to reduce the environmental impact of inhalers and improve inhaler technique. With your help, we can do it.
Read more about RPS action on sustainability in healthcare