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Climate friendly asthma inhaler swap encouraged

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Nurses and other clinicians should consider swapping asthma patients onto more environmentally friendly types of inhaler, where it is safe to do so, says a professional body.

The British Thoracic Society has suggested clinicians consider switching patients from metered dose inhalers to non-propellant devices, whenever they are likely to be equally effective.

“We care for patients who are particularly vulnerable to the effects of climate change”

British Thoracic Society

The society highlighted that non-propellant devices have a “carbon footprint” that is roughly 18 times lower than metered dose inhalers.

It has published a Position Statement on the Environment and Lung Health, which sets out things healthcare professionals can change, such as inhalers, to “make a difference in their workplace”.

The society highlighted that the UK was “unique in its very high use” of metered dose inhalers. They represented 70% of UK sales in 2011, compared with fewer than half in other European countries.

It accepted the “complete elimination” of metered dose inhalers may be impossible due to patient preference and the need to generate sufficient inspiratory flow to activate non-propellant devices.

However, it said it encourages “all prescribers and patients to consider switching [metered dose inhalers] to non-propellant devices whenever they are likely to be equally effective”.

“When making a switch, clinicians need to ensure that patients learn and maintain the correct technique,” it said.

It noted that changing devices could also be used as an “opportunity to optimise the patient’s therapy” and to simplify their technique by changing to devices that are inhaled in the same way.

“[This] position statement is an important step towards making the NHS more sustainable”

Stephen McDonough

In addition, it said schemes for the collection of used inhalers were important, as recycling of the plastic and metal components was “desirable”.

The society said it encouraged clinicians to “promote inhaler recycling by informing patients of existing schemes, including information on patient information leaflets and facilitating recycling in hospitals”.

In the position statement, the society said: “Healthcare professionals have a duty to protect and promote the health of patients and the public and climate change currently represents the greatest global threat to public health.

“Professionals working in respiratory medicine have an important role in combating climate change and developing sustainable practices. We also care for patients who are particularly vulnerable to the effects of climate change,” it stated.

“Action is crucial if we are to protect the health of our patients now and in the future,” said the society in its position statement.

It added that it would also be developing part of its website to “provide further information and examples of good practice”. In the meantime, it noted that it had recommended the following five simple actions:

  1. First and foremost, read the Position Statement – and share it with colleagues
  2. Talk to the ‘sustainability lead’ in your place of work - find out how your organisation measures up, and what more could be done
  3. Consider switching from metered dose inhalers (pMDIs) to non-propellant devices (which have a carbon footprint roughly 18 times lower than pMDIs), whenever they are likely to be equally effective
  4. Always promote (where clinically indicated) high value treatments and interventions, such as smoking cessation, flu vaccination etc. They promote health and reduce future costs
  5. Tell us what you’re doing that is successful in your workplace – we’re keen to see and share best practice: bts@brit-thoracic.org.uk

The initiative was welcomed by inhaler manufacturer GlaxoSmithKline. Dr Stephen McDonough, GSK’s UK and Ireland Medical Director, described the environmental position statement as an “important step towards making the NHS more sustainable”.

He said: “BTS’s encouragement to use inhalers that are more sustainable – that is, non-propellant devices, where they are likely to be equally effective for patients – shows how the NHS can do what’s best for the environment.

“We’re also pleased that our Complete the Cycle recycling and recovery scheme – the first scheme for all respiratory inhalers and not just those manufactured by GSK – has been referenced [by the BTS],” he added.

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