I am very pleased to release our latest Guest Blog - in quick succession! - following Mr Adam O’Neill’s offering on 24th March 2023. We are on a roll!! Great to see.

Guest Blog 14 is related to the provision of environmentally friendly healthcare for those patients experiencing respiratory disease, with quality of care in mind.

The following piece has been kindly provided by Carol Stonham MBE, who is a Registered Nurse and the Primary Care Respiratory Society (PCRS) Policy Lead.

Following 26 years working in general practice, Carol now works at Gloucestershire ICB on the Respiratory Clinical Programme Group and is the CYP Asthma Clinical Lead. Carol has also been appointed as a co-clinical lead of the NHSE South West Respiratory Network. Carol is the past Executive Chair of PCRS – the first non-doctor and first female to take the chair. She is current policy lead for PCRS. She is also a director of the UK Lung Cancer Coalition, and a board member of the UK Inhaler Group and National Asthma and COPD Audit as well as sitting on the NHS Long Term Plan Respiratory Delivery Board. She also co-chairs the Lung Health Task Force early and accurate diagnosis group and is a member of the NHS Long Term Plan Breathlessness Diagnosis group. Carol received Queen’s Nurse award in 2007 and in 2016 was awarded an MBE in the Queen’s New Year Honours list for Services to Nursing and Healthcare. Clearly, we are elated to have Carol’s contribution here at www.pharmascholar.co.uk!!

Without further a do, here is Carol’s Guest Blog:

“Greener respiratory healthcare – keeping focus across the whole pathway.

We are living under the shadow of a climate crisis knowing we must act to reverse the movement towards environmental disaster. So how does that apply to the delivery of healthcare? We have NHS targets to achieve carbon net zero by 2040 for the emissions we control directly – so NHS facilities and transport for example – with a slightly longer timeframe for emissions we can influence such as medicines, waste and water, staff travel aiming to be net zero by 2045 [Ref. 1].

The medicines we prescribe play an important part. Medicines account for 25% of the NHS carbon footprint with inhalers reported as contributing 3% of this [Ref. 1]. The majority is from the propellants currently used in pressurised metered dose inhalers (pMDI). The Impact and Investment Fund primary care contract (IIF) [Ref. 2] focussed in part on this in 2022-23 incentivising the move from these inhalers to using increasing numbers of dry powder inhalers as the carbon footprint is considerably less. The respiratory incentives have been removed from the 2023-24 contract with the focus moving to patient access in primary care.

It is, however, vital that we don’t lose sight of the bigger picture and the quality of respiratory care we offer our patients. There are unofficial reports of mass switches of inhalers to achieve the required targets. This will have collateral damage as patients will not have been coached in correct inhaler technique when changed, might disengage from services or stop prescribed inhaled medication which could result in increased symptom burden, acute exacerbation of the condition, hospitalisation or worse.

Another aspect of the IIF contract was to reduce Salbutamol use and increase preventative medication use in people with asthma. This has the potential to reduce the carbon footprint associated with treating people with asthma. If we focus on the whole patient pathway from, where possible, preventing long term respiratory disease and where it does occur being sure that it is diagnosed in a timely and accurate way. If we then focus on good disease control avoiding symptoms that require regular and frequent use of rescue inhalers, avoid acute exacerbations and the unscheduled medical appointments and travel associated with these, and in particular avoid hospitalisation which in itself has a considerable carbon footprint, the inhaler we prescribe becomes less important.

Where it is appropriate, and where the patient has been involved in the decision to change and can demonstrate competent use of the new device, a dry powder inhaler should always be the first choice. If the patient is unable to reliably demonstrate the correct technique with a dry powder or has reason to not want to change then it is appropriate to continue treatment using a pMDI.

New propellants in development for pMDI inhalers will have a much lower carbon footprint that will be almost equal to using a dry powder. These are likely to be available from 2025 but will be phased in across company inhaler portfolios.

Whilst we cannot ignore the climate crisis, we need to consider it in the context of the individual patient and the whole patient pathway. We need to think about how our actions contribute to global warming but also how, by delivering patient centred care with supportive education and self-management skills, we can improve the clinical outcomes and reduce the effect on the environment. That is the win-win we need to work towards.

References

1. NHS England (2022) Delivering a ‘net zero’ national health service. Available from https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf [Last accessed 31.3.2023]
2. NHS England (2020) Impact and investment fund guidance 2020-21. Available from https://www.england.nhs.uk/wp-content/uploads/2020/09/IIF-Implementation-Guidance-2020-21-Final.pdf [Last accessed 31.3.2023]”

Thanks so much for your fantastic contribution Carol, we really appreciate it here at www.pharmascholar.co.uk. We firmly believe that others will benefit from the critical approach contained within and ultimately patient care will be enhanced across the United Kingdom and beyond.