Switch from global IIF target to powder inhalers could damage patient care, expert says

GPs should avoid the mass switch of patients to more environmentally friendly inhalers as prompted in the Investment and Impact Fund, as it risks damaging patient relationships and disease control, a respiratory expert has warned leading.

Speaking on Pulse Live, Professor Omar Usmani, professor of respiratory medicine at the National Heart and Lung Institute, said healthcare professionals needed to take an individualized approach rather than striving to achieve a target.

“I fear that we will achieve a general change without patients being seen, which will inevitably lead to worsening asthma control and COPD control.”

He added that research he was presenting at the American Thoracic Society conference suggested this approach could be counterproductive.

“We looked at the evidence of when you make a change in coverage for non-clinical, therefore economic or environmental reasons, and in fact what we found was that it harms the doctor-patient relationship.

“If I change patient and I did it remotely, and the patient is not satisfied, then he will not adhere to this treatment. The concern is that asthma or COPD control is getting worse and in fact when trying to save the environment the reverse is happening due to increased presentations, hospital admissions , travel time and increased resources,” he said.

Metered-dose inhalers make up 3% of the overall NHS carbon footprint and shared decision-making on low-carbon alternatives is one of the steps towards the goal of a net-carbon-neutral health service by 2040.

A a total of 27 points were included in the IIF to reduce the proportion of all inhalers other than salbutamol that are metered-dose inhalers (MDIs) in those over 12 with a threshold between 35 and 44%.

It says that for most patients, metered-dose inhalers provide no benefit over dry powder alternatives, but any decision to switch should be clinically appropriate and made through shared decision-making.

Another 44 points are available for prescribing low-carbon salbutamol MDIs to reduce the carbon footprint of PCNs.

A UK study of asthma patients published in February found that switching asthma patients from a metered dose inhaler to a dry powder inhaler significantly reduced their carbon footprint without loss of asthma control.

The Primary Care Respiratory Society has called on all inhaler suppliers to publish the carbon impact of their devices and commit to a rapid transition to low-carbon propellants from 2025.

Professor Usmani, who spoke at Pulse Live in London in April, added that although we all have a responsibility to reduce our carbon footprint and protect the environment, the greenest inhaler was the one the patient could use effectively. Older people and people with severe asthma will struggle with dry inhalers, he said.

“People think devices are interchangeable on their pharmaceutical performance, and they’re not,” he said. “Having patients better controlled with an inhaled corticosteroid according to BTS or ERS guidelines will reduce the need for the blue inhaler and, therefore, lessen the impact on the environment,” he added.

He also acknowledged that the requirement as set out in the IIF was daunting for NCPs. “It requires investment, resources and time. You can’t do this in 10 minutes.

“I have concerns with this cover change approach, really, and I could be a small voice in a really big pond. I’m an environmental advocate, but I’m also a patient advocate.

Work to reduce the carbon footprint of inhalers is part of a wider NHS policy to improve the use of inhalers overall for better patient outcomes.

An NHS spokesperson said: “Clinicians allow patients to choose more environmentally friendly devices, including dry powder inhalers, when it is clinically appropriate for them to do so and as part of a decision-making conversation. shared with patients.