Respiratory care has some of the biggest problems (inhalers) and many good solutions for sustainable healthcare.

The impact of respiratory virtual clinics in primary care on responsible respiratory prescribing and inhaled corticosteroid withdrawal in patients with COPD: a feasibility study

Poster which was presented at the BTS winter meeting 2014.

King's Health Partners

January, 2015

Committee on Climate Change report and SDU call for NHS feedback on overheating in wards

The Committee on Climate Change has produced a recent report entitled 'Managing climate risks to well-being and the economy'

Respiratory fellowship plans - can you help

We (CSH) are looking for funds for a 2-year Sustainable Respiratory Care Fellow who would work with us and this Network on:

BMJ editorial - Inhaled drugs and global warming: time to shift to dry powder inhalers

As atmospheric carbon dioxide levels top 400 parts per million, an editorial in this week's BMJ draws attention to the impact of respiratory inhalers on global warming.

CleanMed 2013 - call for case studies

Plans underway for a Sustainable Respiratory Inhalers Programme

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 propose a programme to change prescribing practices such that DPIs are used in preference to HFC-driven inhalers where not clinically contra-indicated.

Sustainable Respiratory Inhalers Programme - Table of Actions

Table of Actions for a Sustainable Respiratory Inhalers Programme - first created in consultation with Sustainable Respiratory Care Advisory Group in February 2013. This table can be updated as actions are completed or proposed.

Centre for Sustainable Healthcare

February, 2013

Sustainable Respiratory Inhalers Programme - briefing note

The continued use of metered-dose inhalers in respiratory care will have a potentially catastrophic effect on global warming if production is not controlled, largely because these inhalers use potent green-house gas hydroflourocarbons (HFCs) as propellants.

Centre for Sustainable Healthcare

March, 2013

Thorax editorial - Prevention is best: lessons from protecting the ozone layer

Published late last year in BMJ Thorax, editorial by Ashley Woodcock: "The Montreal Protocol was signed 25 years ago. As a result, the irreversible destruction of the ozone layer was prevented.

Ashley Woodcock

July, 2012

Dr Vince Mak speaks about value in respiratory prescribing

Vince Mak's talk presents an important opportunity to reduce environmental harm from use (and over-use) of respiratory inhalers, which have a huge carbon footprint due to the use of HFC propellants:

NHS London Respiratory Team Conference

October, 2012

Cradle to Gate

Greenhouse Gas Accounting Sector Guidance for Pharmaceutical Products and Medical Devices

A consortium of major global companies has been working with the NHS SDU to agree standards for reporting of carbon equivalents emissions for the manufacture of drugs and medical devices. The report was launched on Friday 30th Nov 2012 at St Thomas' Hospital in London and is a real achievement, albeit only the beginning of a lot more work.

Sustainable COPD Inhalers

The document is a framework for a review of key issues in inhaler use leading to 3 action points.

Centre for Sustainable Healthcare

July, 2012

Disruption as opportunity

David Pencheon has been quoted recently as seeing opportunity in the disruption caused by the passing of the Health and Social Care Act.

Article n the Guardian on pharmaceutical waste in the NHS

Not sure whether people have seen this article in the Guardian:

Greener Inhalers for the UK

The Centre's Sustainable Respiratory Care group will lead research on why the UK continues to use inhalers with a much higher carbon footprint than other European countries.

Following the Montreal protocol banning the use of CFC gases in 1987, many countries moved directly to a new technology for inhalers based on Dried Powder (DPIs) while the UK still prescribes a majority of metered dose inhalers (MDIs) which use powerful greenhouse gases.

Selected topics for Sustainable COPD 2012

Inhalers will be the primary focus of our research over the next 4 months - looking at both a clinician-focused shift from MDIs to DPIs and a patient-focused recycling intiative.

Centre for Sustainable Healthcare

May, 2012

Sustainable COPD 2012 Topic Selection Consultation

Sustainable COPD 2012 Consultation – selection of content areas for research and implementation projects.

Centre for Sustainable Healthcare

April, 2012

Sustainable COPD Summit 23.3.2012 - Slides (second batch)

More slides from the 23 March 2012 Summit, "Sustainable Respiratory Care: High Quality Low Carbon" attended by leading members of the respiratory care community.

Centre for Sustainable Healthcare

February, 2012

Respiratory Medicine: High Quality, Low Carbon

On the 23rd of March I was lucky to be among a group of respiratory professionals, representatives from primary care, nursing, academic and the pharmaceutical industry as we came together to discuss how Respiratory medicine contributes, and can help to reduce the carbon footprint of the NHS.

Sustainable COPD - your views needed

Dear Network,

Pages

Browse this Networks's Resources in the Resource Library

New BTS asthma guidelines encourage use of low-GWP inhalers

Section 8.6 of the new BTS/SIGN Guideline for the management of asthma highlights the environmental impact of metered dose inhalers (pMDI) and recommends that inhalers with low global-warming potential (GWP) should be used when likely to be equally effective.

British Thoracic Society

July, 2019

Asthma UK inhaler videos

Are you confident in teaching patients how to use their inhalers? The first step in improving environmental sustainability of inhaler use is to ensure that people use the correct technique to get the drug to where it is needed.

Asthma UK

July, 2019

Patient and Environmentally friendly spacer for Metered Dose Inhalers

Asthma summary

Asthma is very common. Almost 10% of people living in the European Union have a diagnosis of asthma. Among children, asthma is the most common chronic medical condition.

April, 2019

NICE patient decision aid for asthma inhalers

This is an information tool to help people with asthma and their healthcare professionals discuss their options for inhaler devices.

National Institute for Health and Clinical Excellence (NICE)

April, 2019

UN report addresses propellant gases in inhalers

A report has just been presented to the United Nations Environment Programme (UNEP) in respect of the Montreal Prot

United Nations Environment Programme

January, 2019

Alternative to pMDI? Reduced environmental impact of a reusable soft mist inhaler

Hänsel M, Bambach T, Wachtel H M32 Reduced environmental impact of a reusable soft mist inhaler. Thorax 2018; 73:A262.

Abstract

Hansel M et al. Thorax

December, 2018

Moving beyond the air quality crisis

Realising the health benefits of acting on air pollution

This report on air pollution describes the current problem, the reasons it exists and the critical need to resolve it, and includes high level recommendations on the measures required to act on it.

UK Health Alliance on Climate Change

October, 2018

Outpatients: the future – adding value through sustainability

The Royal College of Physicians published a new report 'Outpatients: the future – adding value through sustainability' which seeks to re-evaluate the purpose of outpatient care and align those objectives with modern-day living and expectations.

November, 2018

Natural resources footprint for NHS and social care

This is the most recent carbon/natural resources footprint of health and social care in England, based on 2017 data. Of note, the greenhouse gas emissions from metered dose inhalers are estimated at 0.85 Mt CO2e, which is around 3.2% of total emissions for the sector.

Sustainable Development Unit, NHS England & Public Health England

September, 2018

Sustainable inhaler prescribing driver diagram

This example driver diagram shows how principles of sustainable clinical practice can be applied to improve respiratory inhaler prescribing. Hopefully it shows a holistic approach (MDI>DPI is not the whole story...).

Centre for Sustainable Healthcare

March, 2017

NICE inhaler decision aid - feedback anyone?

Does anyone have experience of using the NICE patient decision aid for inhalers (which includes a section on environmental impacts)?&nbsp

Doctors call for nonviolent direct action over climate crisis

"More than 1,000 doctors including 40 professors, several eminent public health figures and past presidents of royal colleges are calling for wides

Climate advocacy networking

Doctors and all health professionals are highly respected.

Inhalers in primary care

Hi all,

NICE encourages use of greener asthma inhalers

"People with asthma will be helped to choose the inhaler that is best for them, and best for the environment, by a new patient decision aid from NI

QI Inhaler Project in Primary Care

Hi all,

Does anyone have experience of reducing MDI prescribing/use in a community GP setting?

Inhalers and NHS Long Term Plan

The NHS Long Term Plan, published earlier this month, makes two references to inhaler climate change

Expert Working Group on reducing the climate change impact of inhalers

A national (English) working group has been formed to establish the approach and a potential target for reducing the climate change impact of

"Can a Whisper become a Roar" A call to action for the healthcare community

"As clinicians we are taught to value evidence based interventions that benefit health and wellbeing.

Calling all Q members (Health Foundation) with a passion for sustainability

Calling all sustainability friends… are you a Q member (Health Foundation)?

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CSH Sustainability School

Oct 01 to 02 2019, 9:30am - 5:00pm

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Frances Mortimer created New BTS asthma guidelines encourage use of low-GWP inhalers in the Sustainable Respiratory Care and Sustainable Primary Care groups

Wed, 7/31/2019 - 4:36pm

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Sat, 7/20/2019 - 2:34pm

Frances Mortimer posted NICE inhaler decision aid - feedback anyone? in the Sustainable Respiratory Care and Sustainable Primary Care groups

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Featured in this Network

Sustainability in QI - the time has come!

Health systems are in constant need of improvement - and in some cases total redesign.

Reducing the carbon footprint of hospital-based care

Nephrologist, Charlie Tomson, gives an overview of the challenge of reducing carbon in the NHS and potential solutions - from energy and waste reduction to Sustainable Care Pathways.

Tomson, C., Future Hospital Journal

February, 2015