Disclaimers

Disclaimer – Projects

Our quality improvement projects have been developed to support quality improvement in general practice.
We recommend using them in combination with current published evidenced based guidance and other established reference sources. If you are using them significantly after the date of initial publication, then you should refer to current published evidence.
Greener Practice does not accept responsibility for any errors, omissions or harm which may occur because of our projects nor any losses which might occur in the calculation of the carbon footprint. Clinical responsibility for actions taken as part of our projects lies with the persons using in practice these quality improvement projects.

The carbon footprint of inhalers for these projects is based solely on the global warming potential (GWP) of the propellant in Metered Dose Inhalers (MDIs). Dry Powder Inhalers (DPIs) do not have any propellent. There are emissions associated with the pharmaceutical ingredients and the delivery device itself which are excluded from these calculations. Generally, the delivery device for both DPI and MDIs is in the range of 0.5-2kg CO2e.
It is important to remember that inhalers are only part of the management of asthma. Well controlled asthma has a much lower carbon footprint than poorly controlled asthma (See https://thorax.bmj.com/content/thoraxjnl/early/2024/01/11/thorax-2023-220259.full.pdf). Patients on SABA alone and those who use three or more SABA inhalers per year are at risk of having poorly controlled asthma. Poorly controlled asthma has a higher emission footprint due to additional treatment (3 or more SABA MDIs per year), exacerbations, additional appointments in primary care, A&E attendances, and hospital admissions.

Calculating the carbon footprint of medicines is complex. Using financial spend-based conversion factors can be an easy way to compare across medicines but is inaccurate and subject to variables such as inflation, patents, and NHS pricing. Medicines Carbon Footprint (MCF) Classifier 2.0 uses molecular weight and chemical structure to estimate the process mass intensity and global warming potential of the active pharmaceutical ingredient in small molecule medicines. It also takes into account the excipients and primary packaging. More information on MCF is available at https://www.yewmaker.com/mcf-classifier. We have used it as a practical way to estimate carbon savings, mindful of the fact that it doesn’t encompass all elements of the carbon footprint of a drug such as transport and is not yet validated in clinical decision making.

Completing this project may help your practice with CQC evidence submission linking to the areas stated. This certificate is not a guarantee of compliance in these areas.