NICE encourages use of greener asthma inhalers

People with asthma will be helped to choose the inhaler that is best for them, and best for the environment, by a new patient decision aid from NICE

A new patient decision aid, released today, highlights that some inhalers have a much higher carbon footprint than others.

The aid will help people with asthma, alongside health professionals, to identify which inhalers could meet their needs and control their symptoms.

Where several inhalers could be viable options, patients can opt for the more environmentally friendly option, which may help to cut the health service’s carbon footprint.[i]

The new aid, partially funded by the Sustainable Development Unit, also says that all used inhalers should be returned to local pharmacies for environmentally safe disposal or recycling.

Inhaler options

The aid describes the different types of inhaler which may be used by the estimated 5.4m people in the UK who have asthma, and how to use them effectively.

Some, called metered dose inhalers, contain propellants known as hydrofluorocarbons (HFCs), which are powerful greenhouse gases. While HFCs help to propel the dose into the patient’s respiratory system, many people will be able to achieve the same benefit from dry powder inhalers (DPIs).

Metered dose inhalers have estimated carbon footprints of 500g CO2eq per dose, compared to 20g in DPIs.

More than 26m prescriptions for metered dose inhalers were written in primary care in England in 2016/17. They made up 70% of UK inhaler sales in 2011, compared with fewer than half in other European countries and just 10% in Sweden.[ii]

Professor Gillian Leng, deputy chief executive of NICE, said: “This aid will help people make shared decisions on which inhaler is right for them, and help them use that inhaler effectively. This can help them to control their asthma, rather than have their asthma control them.

“People who need to use metered dose inhalers should absolutely continue to do so – but if you have the choice of a green option, do think about the environment. Cutting carbon emissions is good news for everyone, especially those with respiratory conditions.”

Technique tips

The aid includes links to a new series of short videos created by Asthma UK, which give simple demonstrations of correct inhaler technique, potentially improving their effectiveness and preventing future exacerbations and attacks.

They support NICE’s guideline on asthma, which notes that poor technique can worsen an individual’s control over their asthma.

[i] This is a goal of the NHS Long Term Plan – see Point 17 in its Appendix

[ii] Inhaled drugs and global warming: time to shift to dry powder inhalers, BMJ 2013;346:f3359 and Climate friendly asthma inhaler swap encouraged, Nursing Times, 23 March 2017

This aid will help people control their asthma, rather than have their asthma control them

Professor Gillian Leng, deputy chief executive, NICE