The continued use of metered-dose inhalers (MDIs) in respiratory care will have a potentially serious effect on global warming if production is not controlled, largely because these inhalers use potent green-house gas hydroflourocarbons (HFCs) as propellants. A cost-effective and safe alternative is available in the form of Dry Powder Inhalers (DPIs), and we (CSH and the Sustainable Respiratory Care Network) propose a programme to change prescribing practices such that DPIs are used in preference to HFC-driven inhalers where not clinically contra-indicated.
Two telephone meetings of the Sustainable Respiratory Care Advisory Group were held in February 2013 to discuss the approach and identify actions to set up the programme.
How to effect change?
Unique to health services is that clinicians decide what to prescribe and therefore are in control. Patients come next – or are on par if they are knowledgeable and confident. Together front line physicians and patients have the power to alter prescribing patterns to reduce harm.
However, the Advisory Group agreed that individual prescribing decisions take place in a context of personal experience and perceptions, local pharmacy arrangements, clinical guidelines and financial constraints. Each of these may need to be targeted for change in order for a large-scale shift away from harmful MDIs.
Next steps
For the majority of inhaler users a safe and effective alternative to MDIs is already available. We believe what is needed is a programme to change perceptions of clinical efficacy, user acceptability and usage, cost-benefit and ultimately prescribing behaviour. To this end we propose to convene a Programme Board of interested parties – from respiratory specialists to patient groups, GPs to environmentalists and pharmacists to health economists - in Spring/Summer 2013. The purpose of the Board is to agree an overall strategy and provide an organisational structure for managing the programme. As part of a Development Phase of the programme we will convene a forum of funders and agree targets, a timeframe and budget.
A table of actions generated from the Advisory Group tele-meetings has been posted in the Resources section of this Network, along with a briefing note for general use.
Please get in touch if you would like to contribute to the set-up of the Programme, or if you are aware of related work which we should be linking to.
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