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How can GPs influence environmental change by switching to lower carbon inhalers and save the NHS much needed funds?
Click here for prescribing information on SPIRIVA® RESPIMAT® (tiotropium) ▼SPIOLTO® RESPIMAT® (tiotropium and olodaterol) and ▼STRIVERDI® RESPIMAT® (olodaterol).
Whilst the COVID-19 pandemic has had a devastating impact across the globe, the dramatic positive effect it has had on carbon emissions has never been seen before.1 However, this improvement in air quality should not be taken for granted and, as experts have commented, this is likely to be a temporary effect as the world starts to return to a ‘new normal’.2 We are still far from reducing our carbon footprint permanently and with the NHS contributing around 22.8 million tonnes of carbon dioxide (CO2) emissions a year,3 it is no surprise that the pharmaceutical industry is stepping up efforts to support reducing the carbon impact of healthcare.
Respiratory disease is one of the biggest killers in the UK,4 with chronic obstructive pulmonary disease (COPD) and asthma affecting millions of people every year.5 Inhalers play a crucial role in disease management, helping to prevent exacerbations and provide symptom control.6 However, the impact of inhalers on the environment is notable and the need for change to lower carbon alternatives has never been more important.7 An estimated 75 million inhalers are dispensed every year in the UK with pressurised metered-dose (pMDI) inhalers,8 the most common type,9 contributing to around 3.5% of the NHS’s total greenhouse gas emissions.7 Policy recommendations and widespread media interest around the environmental impact of inhalers has led the NHS to prioritise switching to lower carbon inhalers, when appropriate, and set out recommendations to support healthcare providers to bring about this change.10 The NHS Long-Term Plan has set a target to deliver a 4% reduction in emissions, including switching to lower carbon alternatives as well as reducing single-use plastics.10
Environmental change is increasingly becoming an area of focus for the healthcare community with complimentary initiatives to the NHS Long-Term Plan in place to support the delivery of lower carbon emissions.11 For example, NHS England and Public Health England are jointly funding the NHS Sustainable Development Unit to help meet these targets,12,13,14 whilst the Environmental Audit Committee has recommended that low Global Warming Potential (GWP)* inhalers should be promoted within the NHS and they advocate that by 2022 at least 50% of prescribed inhalers should be low GWP.7
Recognition of the importance of respiratory medicine’s carbon footprint is highlighted in the National Institute of Clinical Excellence’s 2019 Asthma Inhaler Decision Aid, which supports patient choice of a more environmentally friendly option, where clinically appropriate, as well as considering other factors such as device size and usability.14
Whilst switching to lower carbon devices will have a positive impact on the environment, healthcare systems could also make considerable savings with these cost-effective options. A recent study highlighted that for every 10% of metered-dose inhalers (MDIs) changed to the cheapest equivalent dry powder inhalers (DPI), drug costs decreased by £8.2 million a year.15
How can GPs make a difference to the environment and their patients?
GPs are at the forefront of patient management so are ideally placed to influence health-led environmental change.16,17 This has been recognised in the recently revised GP contract, which stated that the NHS intends to optimise the quality of prescribing MDIs where a lower carbon option is clinically appropriate.18 Advocating initiatives to improve air quality and minimising short and long-term damage to the environment is also key for the Primary Care Respiratory Society, including recycling schemes for inhaler devices and appropriate switching to environmentally friendly alternatives.19 Supporting patients in choosing the right inhaler for their needs and adopting a more considered purchasing approach can affect change and bring the NHS closer to achieving its sustainability goals.
Shared decision-making is key to achieving this objective as it supports both healthcare professionals and their patients to maximise treatment adherence, which includes using their inhaler correctly and minimising medicines wastage.20,21 The ability to inhale properly from the device is key so that medication is transported straight into the lungs where it is needed. However, not all inhalers – and not all patients – are the same. It is important that greater consideration is given to the patient’s ability to use the device and any potential implications this may have.20,22,23
The pharmaceutical industry’s commitment to sustainability
The pharmaceutical industry plays a crucial role in helping to reduce the NHS’s carbon footprint and Boehringer Ingelheim is committed to supporting the NHS reduce the carbon impact of inhalers and single-use plastics.
With a long heritage in respiratory medicine and a strong commitment to improving patients’ lives, Boehringer Ingelheim has dedicated efforts to creating value for customers via scientific innovation and sustainable healthcare.
As one of the pharmaceutical companies investing in product innovations that contribute towards the NHS’s sustainability goals, Boehringer Ingelheim has dedicated itself to more sustainable ways to run its business. For example, its low carbon impact, propellant free soft-mist inhaler, Respimat® reusable, has a carbon footprint approximately 20 times smaller than that of an ipratropium pMDI and was recently made reusable, with the potential to reduce this footprint by an additional 71%, when used with six cartridges.24,25,26,27
Also central to Boehringer Ingelheim’s business are collaborations with sustainability initiatives such as memberships of the Executive Committee of the Sustainable Healthcare Coalition to address sustainability issues in healthcare, the UK Inhaler Group and the International Pharmaceutical Aerosol Consortium (IPAC).
Healthcare providers and industry are pivotal to environmental change, and together bring the NHS one step closer to achieving its sustainability goals and moving towards a brighter, environmentally friendly future for society as a whole.
*Global Warming Potential (GWP) is a measure of how much energy the emissions of one ton of gas will absorb over a given period of time, relative to the emissions of one ton of carbon dioxide (CO2).28