Ventolin to Salamol Swap - Low Carbon Asthma Care

In 2019 the NHS Long Term Plan committed to reducing its carbon footprint by 51% by 2025; including a reduction of 4% by shifting patients from MDIs to DPIs.

In England approximately 70% of inhalers prescribed are pMDIs, most are short acting beta-agonist inhalers (SABA) such as salbutamol. Alternatives to pMDIs, such as dry powdered inhalers (DPIs) and soft-mist inhalers (SMIs), have a much lower carbon footprint and can be safely and effectively used by many patients. DPIs do not require spacer devices and often have dose counters to aid use.

If a pMDI is needed or preferred by the patient, the brand and dosing regime can help minimise carbon footprint by:

• Avoiding use of branded Ventolin Evohaler, Ventolin 100mcg Evohaler has more than double the carbon footprint of other Salbutamol pMDIs.
• Prescribing inhaled corticosteroids to minimise the number of doses required for the same dose e.g. 1 dose of 200mcg Clenil or Soprobec twice a day rather than 2 doses of 100mcg Clenil or Soprobec twice a day effectively halving the carbon footprint of treatment and may be easier and cheaper for the patient.
• Avoiding use of Flutiform or Symbicort pMDIs (not the turbohalers) These have a much higher carbon footprint than other pMDIs.

Any dosing/ device changes need careful discussion with patient by the GP practice. This is not a blanket swap with no opportunity for the patient to ask questions. If you find this is happening without the patient’s consent please let us know to feed back to the CCG.

Expected Salbutamol inhaler switch by local GP practices – quick win for carbon emission reduction

**This is not a change in device so not eligible for NMS**

Salamol produces half the carbon emissions of Ventolin evohaler. The canister is smaller and contains less propellant for the same number of doses.

What your local GP practice might be doing:

• Sending an AccuRx (SMS) message to patients explaining that their current Ventolin inhaler has a higher carbon footprint to other alternatives (e.g. Salamol) and to contact their practice if they would like to change to a ‘greener’ device
• Discussing this with patients during their annual reviews
• Tackling over-use of SABAs alongside switching to greener alternatives

All practices and PCNs have been asked to liaise locally with their community pharmacies BEFORE switching to ensure stock availability.

Alongside this work the Wessex Asthma guidelines have been updated, and include some useful information around greener inhalers.

The device pictures link straight through to inhaler device instructional videos.

• Download the guidelines here

**NOTE: If the patient changes device i.e. pMDI to DPI they ARE eligible for the New Medicine Service**

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More information on the carbon footprint of inhalers can be found in an asthma toolkit produced by Greener Practice.

• Asthma toolkit