Some patients switched to ‘greener’ inhalers without consultation, experts say

Patients in England are having their inhalers changed without proper consultation which could lead to worsening disease control, respiratory experts have said The Pharmaceutical Journal.

Their demands came as Primary Care Networks (PCNs) are to begin work on switching patients from metered-dose inhalers (MDIs) to dry powder inhalers (DPIs) and gentle-mist inhalers (SMIs), which do not do not require propellants which could contribute to climate change.

In September 2021, a document published by NHS England – which detailed the NCPs’ plans for 2021/2022 and 2022/2023 – set four goals to support improved respiratory care and health outcomes for people with asthma.

The targets have been put in place to reduce avoidable carbon emissions by encouraging the choice of low carbon inhalers, when clinically appropriate.

The document said additional guidance would be provided “to support shared decision-making and patient inhaler choice”.

However, targets have been delayed until April 2022 to ease the workload on GPs during the Omicron COVID-19 surge, but respiratory experts say patients in some areas are already being switched . en masse.

Toby Capstick, consultant pharmacist in respiratory medicine at Leeds Teaching Hospitals NHS Trust, said he had been contacted “by a number of pharmacists and GPs” expressing concern about the non-consensual inhaler changes.

“I was contacted by a GP saying their colleagues were switching patients from an MDI to a PGD – same drug, or drugs, but in a different device – but they weren’t checking the inhaler technique “, he added.

“She wanted advice because a number of [patients] were getting worse…because it wasn’t done with the patient, it was causing asthma control to deteriorate – patients were noticing and coming back to the practice.

Capstick added that he had also been contacted by Community Pharmacy West Yorkshire following similar reports of a general change in a GP practice and PCN in the area.

“Patients had no idea until they got their prescription. Some had received a letter but hadn’t really read it and there was information on the practice’s website about it – but it wasn’t about proactively contacting these patients, getting their consent and check their inhalation technique.

He added that although he had only been contacted by “a handful” of people, it was likely to “only touch the surface” of the problem.

Omar Usmani, professor of respiratory medicine and consultant physician at the National Heart and Lung Institute (NHLI) at Imperial College London, said he was also aware that some patients had switched inhalers without proper consultation and that this was “deeply disturbing”.

“Indeed, in the climate of informed patient consent, patient empowerment and active patient engagement, this is clearly incorrect practice,” he added.

There are inherent risks in changing patients’ inhalers without seeing them and without obtaining their consent, leading to patient dissatisfaction and diminished confidence in their medication.

“[It could also] impact their perception of the control of their lung disease, [an increase in] use of resources and waste of medicines… and above all, worsening of their clinical condition and damage [to] their trust and relationship with their healthcare professional.

Usmani added that it was “imperative” that prescribers do not undertake “broad process-oriented switching”.

“Every patient with an inhaler, or any new patient, should have their inhaler checked. We need to train our patients in the correct use of their inhaler and ensure that a patient can use their inhaler with confidence.”

NHS England was approached for comment but declined, pointing to a previous comment from October 2021 saying the incentives for PCNs on inhalers were “the product of extensive clinical input and patient engagement”.

Read more: Greener inhalers: are we setting the wrong targets?