OBJECTIVES: To identify the environmental impact of low carbon inhaler usage vs traditional inhaler options and the impact of plastic use (none re-usability).

METHODS: We quantified the number of inhalers across each device class for respiratory disease used at a primary care health centre level across NHS England during 2019, the data were extracted from NHS practice level prescribing data. Devices were categorised into 3 distinct types, dry powder (DPI), soft mist inhaler (SMI), and pressurized metered dose inhalers (MDI/pMDI).

We calculated the potential number of inhalers that could be saved from landfill due to switching to re-usable options within the LAMA & LAMA/LABA class. We also identified the percentage of pMDI inhalers as a proportion of SAMA, SABA, LAMA, LABA, LAMA/LABA, ICS and ICS combinations and the eligibility of practices to support the attainment of national carbon footprint reduction targets set out by NHS England within their national policy documentation (Alderwick H, Dixon J. The NHS long term plan).

RESULTS: Initial results showed that during the study period 61,326,522 inhalers were prescribed in England across medication classes and device types. Based on devices prescribed 44,054,956 were pMDI, which represents 72% of all the devices with corresponding potential impact on CO2 emissions. In the LAMA and LAMA/LABA class 5,452,649 and 2,104,787 inhalers were used in 2019; from those only 15% and 10% were re-usable devices respectively.

CONCLUSIONS: The healthcare industry has a significant opportunity to reduce its carbon footprint and to be more environmentally friendly. The use of low carbon inhalers can contribute to this with the next generation of re-usable devices entering the market, combined with national healthcare policy incentives (NHS England; Updated to the GP contract agreement 2020/21 – 2023/24; 2020 February 6) to prescribe low carbon inhalers wherever clinically appropriate.