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Switching to a lower carbon Salbutamol pMDI

This Project takes less than 10 hours for a practice with 10,000 patients

Can be done by a GP, Pharmacist, Nurse, Trainee or Student

Green Impact for Health Toolkit area: Prescribing & Quality Improvement

CQC Areas

  • Effective (Delivering Evidenced Based Care)
  • Well-led (Learning, Improvement & Innovation)
  • Safe (Medicines Optimisation)

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The benefits of this project

Project benefits for Your Patients

Benefits for Your Patients

  • Patients made aware of how efforts being made to reduce the environmental impact of care safely
Project benefits for Your Practice

Benefits for Your Practice

  • Improves staff engagement on green initiatives by demonstration of how actions in workplace can significantly reduce environmental impact of care
Project benefits for The Planet

Benefits for The Planet

  • Can reduce the carbon footprint associated with SABA prescribing by more than 50%.
  • Helps to meets NHS Net Zero targets on inhaler carbon footprint reduction.

Opportunity for improvement

  • There are different brands of salbutamol pMDIs that have significantly different carbon footprints due to the volume of hydroflouracarbon propellant in the canister. These inhalers are equally clinically effective but have a very different carbon footprint.
  • As there is no change in device type, this project can be done fairly quickly, in the same way that medicine switches are done where there is an equally effective and cheaper alternative.
  • Patient resources are available which explain the reasons for switching to lower carbon, equally effective salbutamol inhaler.
  • The NHS has set the target of reaching net zero by 2040 for the greenhouse gas emissions which it can control (‘NHS Carbon Footprint’). Inhalers are included in this scope and account for approximately 13% of this carbon footprint in 2019.
  • This project should not detract from assessing inhaler technique at asthma review and ensuring patients are on the most appropriate inhaler device for them. In line with the 2024 BTS/NICE/SIGN asthma guidance, many people with asthma will benefit from a move to combination ICS-formoterol inhalers. These combination ICS-formoterol inhalers can be DPIs in many instances so that in time fewer people with asthma will need salbutamol pMDIs.
  • You might like to create a SMART goal for this project e.g. to have run the search and sent a patient information resource explaining the change in medication within 1 month.
  • See disclaimers

How to carry out this project

  1. Look at your baseline data

    What is the current prescribing practices around salbutamol pMDI. How is your practice doing in comparison to other local practices, regionally or nationally.

    Practices in England can look at their prescribing data in the following places.

    epACT2: Respiratory – Carbon Impact Dashboard. Measure: Prescribing of a lower carbon SABA MDI inhaler as a proportion of all SABA MDI prescribing (higher the better)

    Open prescribing: Greener NHS measure. Measure: Environmental impact of inhalers – average carbon footprint per salbutamol inhaler (lower the better).

     

  2. 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.

  3. Identify Patients

    Search for patients aged 5 and over who have a diagnosis of asthma

    • AND have been issued Ventolin Evohaler pMDI in the last 12 months
    • OR have been issued generic Salbutamol pMDI in the last 12 months

    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.

  4. Inform patients about the change in inhalers

    Contact all patients on list with explanation of the 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

    For each patient change the repeat prescription to your chosen device.

    Resource: SMS template for change from Ventolin to 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. For more information watch this video bit.ly/3ARa9Yg or read this leaflet bit.ly/3RJhWgf. For a reminder of how use your inhaler, see: https://asthma.org.uk/advice/inhaler-videos/pmdi/

  5. Measure your impact

    Resource: Run-chart Tool

    View

  6. Re-Audit

    Review the results, summarise learning, share with practice team, and decide if any changes are needed to improve the process.

    Decide when to re-audit again to ensure the change has lasted e.g. 2-3 months and use the Project Monitoring form to keep track.

    Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.

Top tip

What I have done: steps, picture, CQC

What needs doing: top-tips (?), case study

This top-tip is also in another section so probably good to double check which is correct -->

Agree on a diagnostic pathway for asthma and how you will follow up patients who do not attend follow up.

Colleague may need repeated clinical sessions to feel confident with the tests in the new guidance and the recommendation that no one should be prescribed SABA alone, even at the point of suspected asthma.

How to scale this project up or down

You could upscale this project by working with your local ICB (England), Health Board (Scotland & Wales) or SPPG Pharmacy Advisor (Northern Ireland) to ensure your asthma guidelines include clear information on the importance of coding 'suspected asthma' and how to treat patients whilst awaiting diagnostic tests.

You could ask about the availability of FeNO testing to aid asthma diagnosis.

You could take it to your Primary Care Network or Cluster to implement across all practices in your area. 

Have you completed this QIP?

Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost savings and other benefits. This project may help with CQC evidence submission (see disclaimers).

Get your certificate

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