NICE decision aid encourages choice of ‘greener’ asthma inhalers

A new patient decision aid, released this week by NICE, provides information to help people with asthma and their healthcare professionals discuss their options for inhaler devices.

“This aid will help people make shared decisions on which inhaler is right for them”

Gillian Leng

The 14-page aid will help people aged over 17 with asthma, alongside health professionals, to identify which inhalers could meet their needs and control their symptoms, it said.

However, the decision aid also highlights that some inhalers have a much higher “carbon footprint” than others, noted NICE.

Where several inhalers could be viable options, NICE highlighted that patients could opt for the more environmentally friendly option.

This may help to cut the health service’s carbon footprint, in line with the new NHS Long Term Plan, according to the institute.

It is the first time that NICE has addressed the carbon footprint of a medicine or medical device in one of its publications. The new aid is partially funded by the Sustainable Development Unit (SDU).

The decision aid also states that all used inhalers should be returned to local pharmacies for environmentally safe disposal or recycling where available.

In addition, it describes the different types of inhaler that may be used by the estimated 5.4m people in the UK who have asthma, and how to use them effectively.

For example, metered dose inhalers, contain propellants known as hydrofluorocarbons (HFCs), which are powerful greenhouse gases.

Metered dose inhalers, containing circa 100 doses, have estimated carbon footprints of 500g CO2eq per dose, compared to 20g in dry powder inhalers (DPIs), which also have around 100 doses.

“Cutting carbon emissions is good news for everyone, especially those with respiratory conditions”

Gillian Leng

By comparison, five doses from a metred dose inhaler can have the same carbon emissions as a nine mile trip in a typical car, according to NICE.

While HFCs help to propel the dose into the patient’s respiratory system, many people will be able to achieve the same benefit from a DPI, suggested the institute.

It highlighted that more than 26 million 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.

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.

“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,” she said.

She added: “Cutting carbon emissions is good news for everyone, especially those with respiratory conditions.”

The aid includes links to a new series of short videos created by the charity Asthma UK, which give simple demonstrations of correct inhaler technique.

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

Asthma UK launched the videos last month, as it revealed that an estimated one million people with asthma in the country could be at risk due to not getting their technique checked.