Reducing greenhouse gas emissions from inhaler use

Inhalers are essential for treating asthma and COPD, with around 60 million devices dispensed in England each year. However, inhalers are not always used optimally, which can lead to poor disease control and avoidable deaths.

In the UK, 70% of inhalers are pressurised metered dose inhalers (pMDIs), which rely on propellant gases. pMDIs account for 3% of NHS greenhouse gas emissions, making them the single largest contributor among all medicines. Their carbon footprint is about 18 times higher than dry powdered inhalers (DPIs), which are a greener alternative.

Improving care and sustainability

To improve patient outcomes and reduce emissions, South East London ICS established the Responsible Respiratory Prescribing Group (RRPG), a subgroup of the Integrated Medicine Optimisation Committee (IMOC). The RRPG brings together healthcare professionals from acute, community and primary care to:

  • Develop consistent and sustainable respiratory prescribing guidelines.
  • Improve disease control through better treatment adherence.
  • Support proper inhaler techniques for patients.
  • Reduce the use of high-carbon inhalers where appropriate.
  • Work with patients to consider lower-carbon inhaler options during shared decision-making.

Tools and support

To help deliver high-quality, low-carbon respiratory care, the SEL IMOC Sustainability Group has developed a toolkit of resources for healthcare professionals. This supports the newly developed Clinical Effectiveness SEL (CESEL) guidelines for managing asthma in adults, children and young people.

Further support is available through Optimise Rx, a prescribing decision support tool used in primary care across South East London. It helps prescribers make safe, high-quality, and cost-effective decisions that align with greener NHS goals.

Sustainability toolkit resources for General Practice

SPECTRA: Identification of SusPECTed seveRe Asthma in adults

SPECTRA primary care clinical system resources have been developed to help identify adults with potential severe asthma, optimise their treatment, and refer them to severe asthma centres when needed:

  • Serious or 2 or more exacerbations.
  • 2 or more issues of systemic corticosteroids.
  • 6 or more reliver inhalers in the last 12 months.
  • Poor symptom control or latest Asthma Control Test score less than 201.

Videos

The videos available in the hyperlinks below may be appropriate for General Practice waiting room screens:

Resources for Community Pharmacies

Label

These labels can be used to encourage patients to return their inhalers to pharmacies for disposal.

Letter

This letter can be used to encourage patients to return their inhalers to pharmacies for disposal.

Staff at all levels can enhance their sustainability knowledge and skills by accessing short courses from the Centre for Sustainable Healthcare.

South East London Integrated Care System

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