2. Whole team approach to offering patients a low-carbon inhaler device
This project aims to reduce the carbon footprint of inhaler prescribing by offering a lower carbon device to all patients aged 12 and over who are on metered dose inhalers. Children under the age of 12 may be too young to take the quick and deep breath needed to use a lower-carbon dry powder inhaler. As described in the introduction to this section, these projects must be done in an individualised and person-centred way. It is imperative that all patients who are switched to an alternative device are shown correct inhaler technique and are followed up.
The process
Step 1: Organise a clinical learning session
Organise a clinical learning session with your practice team including all clinicians who see asthma patients. Prior to the meeting send your clinical team resources to help them learn about disease control and inhaler device choice.
Discuss your team’s understanding of approach to consultations around disease control and device choice and inhaler technique
Is everyone confident and competent to teach the inhaler techniques of the low carbon inhalers on your formulary?
Resources:
- Greener Practice guide to inhaler device change
- NICE patient decision aid on inhaler device choice
- Link to this toolkit
- Ask clinicians to review toolkit education videos
- Inhaler technique videos
Step 2: Choose your asthma template
Look at the PCIT asthma review template. Does this help with discussing device choice at asthma reviews? As a team would you like to adopt using this template for asthma reviews?
Resources:
Step 3: Checking Inhaler technique
How will you demonstrate inhaler technique and how will you be confident that the patient knows how to use a new inhaler device? PresQIPP have done a 1 hour webinar looking at this.
You may wish to acquire placebo devices on the low-carbon inhalers on your formulary form your local pharmaceutical rep.
You may also wish to send a patient a follow up message with a video showing inhaler technique.
Resources:
- PresQIPP video on inhaler technique webinar
- SMS on inhaler technique (see below)
- https://www.asthma.org.uk/advice/inhaler-videos/
Step 4: Information to patients
Do you wish to send all your asthma patients information on low carbon inhaler devices? Will you put this information into your invitation to asthma review, put it on your practice website, send a bulk message to all asthma patients?
Resources:
- Patient information leaflet on Inhalers and the environment
- Email with link to greeninhaler.org
Step 5: Integrate work or target group of patients?
Discuss whether you wish to proactively target certain groups of patients (such as those on highest carbon footprint inhalers – see device projects 3-5 ) or if you will integrate all this work into routine asthma review.
It’s important in this step to think about workload, how this will be managed and by whom.
Step 6: Follow-up patients
Consider how you will follow up patients who have had their device changed 4-6 weeks later. Will you organise a face to face appointment or a video check.
TIP: add patients who have been switched to a waiting list for follow-up
Resources
SMS templates
Offering a lower carbon inhaler
SMS 1 of 2:
Learn about different inhaler device choices for your next asthma review. Watch https://bit.ly/3T90yTn or read https://bit.ly/3fSys0h. Keep taking your current inhalers as prescribed
AccuRx SMS
We’re offering patients the choice to change their metered dose (aerosol spray) inhalers to a different type of inhaler called a dry powder inhalers. These inhaler suit some people better and also have a lower carbon footprint. This can be discussed at your next asthma review. For more information watch this video https://bit.ly/3T90yTn or read this leaflet https://bit.ly/3fSys0h. You can also learn more at this website www.greeninaler.org
In the meantime keep taking your inhalers as presribed.
—–
Follow-up after change in inhaler
SMS 1 of 2:
We hope you are getting on well with your new inhaler. If there are any issues, please [book a review with asthma nurse/ doctor].
SMS 2 of 2:
Remember, if you’re needing your reliever (blue) inhaler 3 or more times per week, this means your asthma may bot be well controlled and you should book an asthma review as soon as possible.
AccuRx SMS:
We hope you are getting on well with your new inhaler. If there are any issues, please book a review. Remember, if you’re needing your blue inhaler three or more times per week, this means your asthma may not be well controlled and you should book an asthma review as soon as possible.
Letter templates
All MDIs
Dear Patient,
As part of our practice commitment to provide excellent care and protect our planet, we are offering patients a choice of inhaler device.
Which of my inhalers does this affect?
We have options for both your reliever (blue) and preventer (brown, pink or other) inhalers, and we can talk about changing one or both of them.
What is the choice?
Most people with asthma currently use metered dose inhalers. These inhalers are also known as aerosol spray inhalers or ‘puffers.’ They contain medicine in a propellant gas which is delivered when you press down on the canister. The alternative to metered dose inhalers are called dry powder inhalers. These contain medicine in a fine powder which is delivered into your aiways when you take a quick and deep breath in. Most people can use a dry powder inhaler effectively. Some people such as children under 12, the elderly or those with severe asthma, may not be able to use them.
Why would I want to change my inhaler device?
Changing your inhaler to a dry powder inhaler may be better for you and the planet.
Dry powder inhalers requie a quick and deep breath in, which suits many people. They don’t need to be used with a spacer, which can make them more convenient. They also come with a dose counter which helps you keep track of how much medication you have used and how much you have left.
Dry powder inhalers do not contain propellant gas like metered dose inhalers. Propellants in inhalers are powerful greenhouse gas that contribute to climate change. Your inhaler may say it is CFC free and this means the gases do not damage the ozone layer, however, they still contribute to climate change. Dry powder inhalers, don’t use gas at all and have a much lower carbon footprint.
However, remember that the most important thing you can do for the environment is for your asthma to be well controlled with an inhaler that is most suitable for you. So please ensure that you ask your healthcare professional to watch you use your inhaler so they can help you use it correctly.
Where can I get more information?
This video has more information about inhalers device choices https://bit.ly/3T90yTn. You can also read this leaflet https://bit.ly/3fSys0h or look online at www.greeninhaler.org
What do I do now?
If you would like to speak about changing your inhaler prescription to a lower carbon footprint option, please contact reception to make an appointment.
OR
You will be contacted in the usual way for your asthma medication review, and at this time we can discuss a change in inhaler prescription with you if appropriate.
Thanks,
[Practice name/ lead clinician]
—–
Follow-up after change in inhaler
Dear Patient,
We hope you are getting on well with your new inhaler.
If you are having any concerns with your new inhaler, have any questions, or if your asthma symptoms have worsened, please [book a review with asthma nurse/ doctor].
Remember, if you’re needing your blue inhaler 3 times a week or more, this means your asthma may not be well controlled and you should book an asthma review as soon as possible.
Many thanks,
[Practice Name/ Lead Clinician Name]