Update to the BTS Environment and Lung Health position statement - low carbon inhalers

Our low carbon inhalers position (appendix A of the BTS Environment and Lung Health position statement) makes recommendations on ways in which the carbon emissions and other environmental impacts associated with the prescribing of inhalers can be reduced in a safe and managed manner which maintains clear patient choice. While we encourage healthcare professionals to work with patients to consider low carbon inhalers where possible, we recognise that switching away from Metered Dose Inhalers (pMDIs) will not be feasible for all patients.

The key recommendations made in the Low Carbon Inhalers appendix to the BTS Environment and Lung Health position statement include the following:

1. Where a new class of inhaler is commenced, this is a Dry Powder Inhaler (DPI).
2. That during all respiratory reviews, prescribers recommend low carbon alternatives to patients currently using Metered Dose Inhalers (pMDIs), where patients are able to use these safely.

• Taking all opportunities, including respiratory reviews, to optimise inhaler technique which may improve drug delivery / lung deposition.

1. The dissemination of information that some devices can be reused and the canister changed, and that prescribers encourage patients to ask their pharmacists about safe inhaler disposal.

BTS is also committed to supporting the expansion of inhaler recycling and disposal schemes, and the provision of information on where these are available.

The statement also sets out the background to these recommendations including data on inhaler types and usage, NHS contracts and guidance on reducing the environmental impacts of inhalers, and related resources and guidance. Our statement is consistent with the BTS-SIGN 2019 Asthma Guideline and the 2019 NICE shared decision aid, and links with the work of the NHS England Sustainable Development Unit.