BTS position statement on the environment and lung health

Alexander Wilkinson's picture

In case you didn't see it, the British Thoracic Society released its Position Statement on the Environment and Lung Health in March along with these 5 action points members can take:

  1. First and foremost, read the Position Statement – and share it with colleagues.  
  2. Talk to the ‘sustainability lead’ in your place of work - find out how your organisation measures up, and what more could be done.
  3. Consider switching from metered dose inhalers (pMDIs) to non-propellant devices (which have a carbon footprint roughly 18 times lower than pMDIs), whenever they are likely to be equally effective.
  4. Always promote (where clinically indicated) high value treatments and interventions, such as smoking cessation, flu vaccination etc.  They promote health and reduce future costs.
  5. Tell us what you’re doing that is successful in your workplace – we’re keen to see and share best practice:


Thanks for this reminder. It

James Smith's picture

Thanks for this reminder. It would be really useful to have an idea of the price difference between MDI and DPI alternatives for different active ingredients. If the difference is small or even in favour of DPIs then I would think that it is a much easier to argue for switching e.g. with clinical colleagues or CCGs. Has anyone done this work? If not done would others like to help make up a quick price comparison table of the main switching opportunities e.g. Salbutamol, commonly steroids etc... We could do it in a shared Google Docs spreadsheet. Then work out if just useful for our info or helpful for wider sharing. 

Just a thought. 


Online resource comparing inhalers already available

Sian Williams's picture

Have a look at this:



James Smith's picture

That's really useful. So at first glance:

Salbutamol - cheapest MDI just under half price of DPI (comparing Easyhaler with Salamol). 

Beclometasone - DPI slightly cheaper than MDI (comparing Easyhaler 200 with Clenil).

Fostair - Same price for DPI and MDI. 

This is much better than I was expecting in terms of price comparison. There is clearly an issue with Salbutamol which woudl make switching hard until the price falls but for steroid inhalers it looks like the prices might be comparable/favourable for DPIs. 

What do we do now with this info? Is it worth drafting something aimed at prescribing leads at CCGs? Is it a matter of doing something to raise awareness among GPs? Or can we pursue this at a national level?

It would seem that anything which is cost saving should be an easy sell given the amount of inhalers used in the NHS and the overall impact on the prescribing budget. I think there were over 11 million Beclometasone inhalers dispensed last year so if we could save 75p per inhaler on 3/4 of these by switching to DPI that would mean an annual saving of over 6 million pounds (and a huge carbon footprint saving). 

Perhaps we need a national medicines management lead to get on board with this. I wonder if we shoudl aim for switching all steroid inhalers (as long as clinically appropriate). Would be worth including the cost neutral but carbon saving switches in this if we can so we don't have to push for this seperately at a later date. We may have to accept that Salbutamol switching will come later once prices change and more acceptability/demand from patients for DPIs. 

What do others think? What next? 


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