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The UK's primary care sustainability network

5. Ventolin Evohaler pMDI to Salamol pMDI or Airomir pMDI

This project aims to reduce the carbon footprint of salbutamol pMDI inhalers by safely switching patients to the lowest carbon option. The carbon emissions for each inhaler are as follows (kg CO2e per inhaler):

Remember that patients with a prescription for generic salbutamol may receive any brand depending on the pharmacy choice. Using this project you can choose to make any of the following switches:

The process

Step 1: Decide on which change is appropriate for your practice

Consider local guidelines and formulary to decide whether to switch to Salamol pMDI or Airomir pMDI or to generic salbutamol and confirm availability and supply with your local pharmacy stocks.

Step 2: Search for patients with the target salbutamol pMDI inhaler on repeats

Create a list of all patients aged 12+ with asthma with repeat prescriptions for Ventolin Evohaler pMDI (and generic salbutamol pMDI, if required).

NB: a small number of patients who use the Haleraid®️ device may need to continue on Ventolin as the smaller version of the device does not fit Salamol.  Haleraid®️ is a device to place over pressurised metred dose inhalers to aid when the strength in the hands of a patient is compromised. It has been discontinued and is currently not available on prescription in the UK but some patients may still use one.

NB: The Volumatic spacer device is compatible with Salamol pMDI but not with Airomir pMDI. The Babyhaler spacer is only compatible with Ventolin Evohaler.

Resource:

  • Search for pMDI on repeats and filter for correct inhaler
Step 3: Inform patients about the change in inhalers

Contact all patients on list with explanation of change and Patient Information Leaflet.

TIP: If available you could give a “reply once” option to opt out by certain date – remember to remove these patients from the list

Resources:

Step 4: Follow-up

Send a follow-up SMS to all patients 4-6 weeks after the change to encourage any patients having issues to get in touch.

Resource:

  • SMS follow-up (see below)
Step 6: Measure your impact

Monitor your progress with this run chart tool based on the four relevant IIF indicators.

Resource:

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 an inhaler that is better for the environment. If you are interested, please book an asthma review.

SMS 2 of 2:
To read more about asthma, your inhalers and the environment, head to www.greeninhaler.org or read this.

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 [Inhalers and the environment PIL link]
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 salbutamol inhaler to Salamol

SMS 1 of 2
We’re changing the blue Ventolin Evohaler to Salamol pMDI brand (same medicine and device, but lower carbon footprint).

SMS 2 of 2
The new inhaler may taste different. This is normal. Read more about this change here.

AccuRx SMS Salamol:
We’re changing your Salbutamol (blue) inhaler prescriptions from the Ventolin to the Salamol brand inhaler. Salamol inhalers contains the same medicine (salbutamol) and are the same type of inhaler as Ventolin inhalers but they have a lower carbon footprint. The new inhaler may taste different. This is normal. To read more about this change, read this leaflet.
For a reminder of how use your inhaler, see: https://asthma.org.uk/advice/inhaler-videos/pmdi/

AccuRx SMS opt out:
To opt out of this change, please contact [reception by DD MMM.]
OR
To opt out of this change, please reply “NO” to this message.

—–

Changing salbutamol inhaler to Airomir

SMS 1 of 2
We’re changing your blue salbutamol or Ventolin inhaler to the Airomir brand inhaler (same medicine and inhaler device, but lower carbon footprint).

SMS 2 of 2
The new inhaler may taste different, but this is normal.

AccuRx SMS Airomir:
We’re changing blue reliever inhaler prescriptions to the Airomir inhaler. It’s the same medicine and device as Ventolin but has a lower carbon footprint. The new inhaler may taste different.
For a reminder of how use your inhaler, see: https://asthma.org.uk/advice/inhaler-videos/pmdi/

AccuRx SMS opt out:
To opt out of this change, please contact [reception by DD MMM.]
OR
To opt out of this change, please reply “NO” to this message.

—–

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

Changing salbutamol inhaler to Salamol

Dear Patient,

As part of our practice commitment to provide excellent care and protect our planet, we are reviewing the prescriptions for some inhalers.

Which of my inhalers does this affect?
This affects your reliever (blue) inhaler, which you use only when you have symptoms. You may know it as your salbutamol inhaler, or by the brand-name Ventolin. Your pharmacy may dispense a salbutamol inhaler with a different brand name.  It appears on your medication list as either of the following:

  • Ventolin Evohaler 100microgram/ dose
  • Salbutamol CFC-Free Inhaler 100microgram/ dose

Why are you changing these inhalers?

Your reliever (blue) inhaler is a metered dose inhaler, sometimes called an aerosol spray inhaler or a ‘puffer.’ This contains a propellant gas in the canister which is a powerful greenhouse gas that contributes to climate change. The Ventolin inhaler has more than twice the carbon footprint of the Salamol inhaler, even though it delivers the same medication, using the same type of device at the same dose. This is because the Salamol inhaler uses less propellant gas.

Ventolin Evohaler = 28.26kg CO2e emitted per inhaler

Salamol = 11.95 CO2e emitted per inhaler

How will my prescription change?
The World Health Organisation has said that climate change is the greatest risk to health in the 21st century.  We want to prescribe inhalers that release less greenhouse gases, to reduce the impact on climate change.  From now on, all prescriptions we issue for blue reliever inhalers will be for the lower carbon footprint Salamol inhaler (Salamol CFC-Free Inhaler 100microgram/ dose). 

What do I need to do?
Salamol contains the same medication as Ventolin and is used in the same way. So, you can continue using your inhaler in exactly the same way. Finish the doses in your current inhaler before starting your new Salamol inhaler.

Some people notice a change in the taste of the inhaler and this is normal.

For a reminder of how to use your inhaler, see: https://asthma.org.uk/advice/inhaler-videos/pmdi/

Remember, if you need to use your reliever (blue) inhaler 3 or more times per week, this means your asthma may not be well controlled – so please make an appointment to speak to a healthcare professional.

What if I don’t want my prescription to change?
To opt out of this change, please [contact reception and let them know].

Many Thanks,

[Practice Name/ Lead Clinician Name]

—–

Changing salbutamol inhaler to Airomir

Dear Patient,

As part of our practice commitment to provide excellent care and protect our planet, we are reviewing the prescriptions for some inhalers.

Which of my inhalers does this affect?
This affects your blue reliever inhaler, which you use only when you have symptoms. You may know it as your salbutamol inhaler, or by the brand-name Ventolin. It appears on your medication list as either of the following:

  • Ventolin Evohaler 100microgram/ dose
  • Salbutamol CFC-Free Inhaler 100microgram/ dose 

Why are you changing these inhalers?
Your blue inhaler is a metered dose inhaler, sometimes called an aerosol spray inhaler or a ‘puffer.’ This contains a propellant gas in the canister which is a powerful greenhouse gas that contributes to climate change.

The Ventolin MDI has more than 3 times the carbon footprint of the Airomir, even though it delivers the same medication at the same dose. This is because the Airomir inhaler uses less propellant gas.

Ventolin Evohaler = 28.26kg CO2e emitted per inhaler

Airomir = 9.72kg CO2e emitted per inhaler

How will my prescription change?
The World Health Organisation has said that climate change is the greatest risk to health in the 21st century.  We want to prescribe inhalers that give out less greenhouse gases, to reduce the impact of climate change.  From now on, all prescriptions we issue for blue reliever inhalers will be for the lower carbon footprint Airomir inhaler (Airomir 100microgram/dose inhaler).

What do I need to do?

Airomir contains the same medication as Ventolin and is used in the same way. So, you can continue using your inhaler exactly the same way.

Some people notice a change in the taste of the inhaler and this is normal.

For a reminder of how use your inhaler, see: https://asthma.org.uk/advice/inhaler-videos/pmdi/

Remember, if you need to use your inhaler more than 3 times per week, this means your asthma may not be well controlled – so please make an appointment to speak to the healthcare professional.

What if I don’t want my prescription to change?
To opt out of this change, please [contact reception and let them know].

Many Thanks,

[Practice Name/ Lead Clinician Name]