Effective respiratory management of asthma and COPD and the environmental impacts of inhalers

Abstract

Over the past few years, multiple health agencies from across the globe have recommended schemes to reduce the carbon footprint of inhalers, encouraging a switch to environmentally friendly alternatives. To control emissions from fluorinated greenhouse gases (F-gases), including hydrofluorocarbons (HFCs), the European Union has adopted the F-gas regulation 1 . Moreover, there is a drive in the UK to reduce the prescribing of pressurised metered-dose inhalers in favour of devices with lower global warming potential 2 . This initiative is in the context of poor asthma outcomes in the UK, particularly with deaths being among the highest in the world 3 , 4 . Furthermore, asthma care in the UK may be delegated to professionals without adequate training. According to the UK National Review of Asthma Deaths, 46% of nurses who had performed reviews on patients who died from asthma had no formal training in asthma care. Moreover, sometimes those performing asthma reviews did not recognise patients who were at risk, which could have resulted in potentially preventable deaths 5 . Thus, we emphasise that the optimal management and quality of care of patients with asthma and chronic obstructive pulmonary disease (COPD) needs to remain the absolute priority for prescribers, to avoid exacerbating outcomes further. Selecting the inhaler device best suited to an individual patient is a challenging process, with many contributing factors. Among these, to reduce the environmental impact of inhalers we believe that it is important to consider correct use 6 , 7 , adherence 8 and acceptability 9 of prescribed devices. The most appropriate and environmentally friendly inhaler is one that a patient will adhere to and use correctly: this minimises wastage and promotes good disease control. Changing a patient’s prescribed inhaler when their condition is stable on their current device risks loss of disease control and is, in our view, clinically irresponsible. If a change is clinically warranted, it must be accompanied with a face-to-face consultation to ensure good inhaler technique and a comprehensive follow-up to confirm sustained clinical control of the disease. This article discusses the importance of combining effective respiratory management of asthma and COPD with environmental considerations (Box 1), and focuses on the UK as an example owing to the distribution of inhaler sales and poor patient outcomes.

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