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(SHORT) GP On The Move - TOPIC #14: Eco - Friendly Asthma Inhalers
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In this shortened version, I share with you some afterthoughts on Topic #14 of the medical audiobook "GP On The Move" - Asthma Review - focusing specifically on eco - friendly asthma inhalers.
WHO AM I:
I'm Mike, a general practitioner working in Greater Manchester, UK. I'm also a music producer and medical university tutor. I make videos about medicine and productivity and I am the author of the now sold out medical audiobook "CSA On The Move: A Practical Audio Guide to the Clinical Management of Common RCGP CSA Scenarios" and the available second edition "GP On The Move".
The massive carbon footprint reduction in changing patients’ pMDIs to DPIs is quite spectacular so let’s see what NICE says about this.
A patient decision aid was released in April 2019 allowing patients to understand the environmental impact of the inhalers they use and you can signpost your patients to this.
The summary is that in the UK, we are far behind other European countries in terms of how many pMDIs we prescribe, and they also give the following statement: Metered dose inhalers have estimated carbon footprints of 500g CO2eq (equivalent carbon dioxide) per dose, compared to 20g in DPIs. So 20g is 4% of 500! I guess to put this into context metered-dose inhalers account for nearly 4% of all NHS greenhouse gas emissions.
This is from a BBC article: The researchers estimate replacing even one in every 10 of these inhalers with a more environmentally friendly type (dry powder inhalers) would reduce carbon dioxide equivalent emissions by 58 kilotonnes. That's like the carbon footprint of 180,000 return car journeys from London to Edinburgh.
So let’s be practical. Before you start switching all your patients onto DPIs, you need to assess whether your patients actually have the required inspiratory effort to suck in the medicine as it were. If you are fancy, you could buy one of these called In-Check for 25-30 quid. Or if you are not fancy like me, you can ask the patient this simple question.
Can you breathe in through your mouth quickly and deeply within 2 to 3 seconds? Yes = DPI
If they say no, then you can ask: Can you breathe in through your mouth slowly and steadily over 4 to 5 seconds instead? Yes = pMDI
Which inhaler am I actually putting into EMIS my clinical system? I know that our patch is working hard on a protocol but it’s not ready yet, so I will make a suggestion based on this document from the GMMMG asthma inhaler choices.
Regular Preventor – Budesonide says DPI – done that’s my pick.
And for the combination – Pete our pharmacist says he likes Relvar and it does say DPI – so done.
Finally, I promised you a bonus at the end. Here’s an easy and quick switch our CCG has suggested to cuts patients’ carbon footprint in half. Swap Ventolin for Salamol. If you look at this table produced by Dr David McKelvey – Ventolin’s Indicative carbon footprint per 28 days (gCO2e) is 1920. And Salamol’s is actually less than half that at 778.
The information contained within this publication was obtained from sources believed to be reliable. Whilst every effort has been made to ensure the accuracy of the material, no responsibility for loss, injury or failure whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the author.
Although every effort has been make to ensure that all owners of copyright material have been acknowledged in the publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention.
All readers should be aware that medical sciences are constantly changing and evolving and whilst the author has checked all dosages and guidance are based upon current indications, there may be specific practices and procedures that differ between localities, countries and nations. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practicing.
#generalpractice #asthma #ecofriendly
WHO AM I:
I'm Mike, a general practitioner working in Greater Manchester, UK. I'm also a music producer and medical university tutor. I make videos about medicine and productivity and I am the author of the now sold out medical audiobook "CSA On The Move: A Practical Audio Guide to the Clinical Management of Common RCGP CSA Scenarios" and the available second edition "GP On The Move".
The massive carbon footprint reduction in changing patients’ pMDIs to DPIs is quite spectacular so let’s see what NICE says about this.
A patient decision aid was released in April 2019 allowing patients to understand the environmental impact of the inhalers they use and you can signpost your patients to this.
The summary is that in the UK, we are far behind other European countries in terms of how many pMDIs we prescribe, and they also give the following statement: Metered dose inhalers have estimated carbon footprints of 500g CO2eq (equivalent carbon dioxide) per dose, compared to 20g in DPIs. So 20g is 4% of 500! I guess to put this into context metered-dose inhalers account for nearly 4% of all NHS greenhouse gas emissions.
This is from a BBC article: The researchers estimate replacing even one in every 10 of these inhalers with a more environmentally friendly type (dry powder inhalers) would reduce carbon dioxide equivalent emissions by 58 kilotonnes. That's like the carbon footprint of 180,000 return car journeys from London to Edinburgh.
So let’s be practical. Before you start switching all your patients onto DPIs, you need to assess whether your patients actually have the required inspiratory effort to suck in the medicine as it were. If you are fancy, you could buy one of these called In-Check for 25-30 quid. Or if you are not fancy like me, you can ask the patient this simple question.
Can you breathe in through your mouth quickly and deeply within 2 to 3 seconds? Yes = DPI
If they say no, then you can ask: Can you breathe in through your mouth slowly and steadily over 4 to 5 seconds instead? Yes = pMDI
Which inhaler am I actually putting into EMIS my clinical system? I know that our patch is working hard on a protocol but it’s not ready yet, so I will make a suggestion based on this document from the GMMMG asthma inhaler choices.
Regular Preventor – Budesonide says DPI – done that’s my pick.
And for the combination – Pete our pharmacist says he likes Relvar and it does say DPI – so done.
Finally, I promised you a bonus at the end. Here’s an easy and quick switch our CCG has suggested to cuts patients’ carbon footprint in half. Swap Ventolin for Salamol. If you look at this table produced by Dr David McKelvey – Ventolin’s Indicative carbon footprint per 28 days (gCO2e) is 1920. And Salamol’s is actually less than half that at 778.
The information contained within this publication was obtained from sources believed to be reliable. Whilst every effort has been made to ensure the accuracy of the material, no responsibility for loss, injury or failure whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the author.
Although every effort has been make to ensure that all owners of copyright material have been acknowledged in the publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention.
All readers should be aware that medical sciences are constantly changing and evolving and whilst the author has checked all dosages and guidance are based upon current indications, there may be specific practices and procedures that differ between localities, countries and nations. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practicing.
#generalpractice #asthma #ecofriendly
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