Climate change poses a major threat to our health as well as our planet. The environment is changing, that change is accelerating, and this has direct and immediate consequences for our patients, the public and the NHS.

Inhalers are a key treatment for respiratory conditions, with approximately 60 million dispensed in England every year. However, inhalers are not always used in an optimal way, which can lead to poor disease control and avoidable deaths.

Inhaler emissions account for approximately 3% of the NHS carbon footprint. The propellant used in metered dose inhalers is responsible for most of these emissions. Alternative options with a significantly lower carbon footprint exist, such as dry powder inhalers.

The UK has a higher metered dose inhalers prescribing rate compared with other European countries. These countries have demonstrated that safe and effective care can still be delivered using other inhaler devices.

Supporting patients over the age of 12 to consider using lower carbon inhalers, where clinically appropriate, creates an opportunity to improve patient outcomes while reducing harmful carbon emissions.

This toolkit has been developed by the South East London (SEL) Integrated Medicines Optimisation Committee Sustainability Group to help provide healthcare professionals with established resources to aid with local implementation of the greener NHS respiratory agenda.

In addition to the resources referred to in this document, there is wrap around support to aid implementation, including:

  • Optimise Rx – a prescribing decision support tool in place across SEL in primary care, advising prescribers on quality, safe and cost-effective prescribing
  • Community Pharmacy Quality scheme – includes an element centered about improving respiratory care for patients which could also be the start bridge the information gap for patients.

Resources for General Practice

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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 treatment and, where required, refer them to severe asthma centres:

  • 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


Resources for Community Pharmacies


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

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

South East London Integrated Care System

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