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The UK's primary care sustainability network

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:

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:

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:

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

Changing to a lower carbon inhaler (if inviting directly to appointment)

SMS 1 of 2:
You may be able to change to a lower carbon footprint inhaler that is better for the environment?  For more info, head to https://www.greenerpractice.co.uk/wp-content/uploads/CANVA-inhalers-environment.pdf 

AccuRx SMS
We’re offering patients the opportunity to change their aerosol spray inhalers to a different type with a lower carbon footprint. For more info, go to www.greeninaler.org or look at this information leaflet.
If you’re interested, please contact reception to book an asthma review to discuss further.
OR
If you’re interested, please reply “YES” & we’ll contact you to make an appointment.

—–

Changing to a lower carbon inhaler (if setting visibility alert)

SMS 1 of 2:
You may be able to change to a lower carbon footprint inhaler that is better for the environment. If interested, discuss at your next asthma review.

SMS 2 of 2:

To learn more about inhalers and the environment read this or go to www.greeninhaler.org

AccuRx SMS 1 of 1:
We’re offering patients the opportunity to change their regular inhalers to a different type with a lower carbon footprint. For more info, head to www.greeninhaler.org or look at this patient information leaflet
If you’re interested, please speak to the nurse or doctor at your next asthma or medication review.

—–

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 blue inhaler 3 or more times per week, this means your asthma treatment could be improved 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 treatment could be improved 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 the opportunity to change their inhaler to a more environmentally friendly 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.

Why would I want to change my inhaler?
The inhalers you are using are called metered dose inhalers. These inhalers are also known as aerosol spray inhalers or ‘puffers’. They use a propellant gas to deliver medication to your airways. This propellant is a powerful greenhouse gas and contributes 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.

Other types of inhalers, such as dry powder inhalers, don’t use gas at all and have a much lower carbon footprint. 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. Dry powder inhalers 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.

Changing your inhaler to a dry powder inhaler may be better for you and the planet. 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 leaflet has more information about inhalers and the environment (link on resources or hardcopy). You can also 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
Please have a read of the information provided and write down any questions you may have. 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]

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Follow-up after change in inhaler

Dear Patient,

As you know, your asthma inhaler was recently changed. 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]