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“In the UK alone, around 60 million inhalers are prescribed annually, accounting for roughly 3% of the NHS’s total carbon footprint.” In this blog, Dr David Linden, Workstream Lead for Respiratory, explores how controlling asthma can be good for the environment as we explore a project that works towards the NHS’s evolving responsibility in sustainability.

In response to the recent Telegraph article by Alex Barton titled ‘Future doctors will be expected to consider climate impact of inhalers,’ it’s important to highlight ongoing efforts that align with this evolving responsibility in healthcare. One of the key developments in this area is the SENTINEL PLUS initiative, led by Professor Mike Crooks, Consultant Respiratory Medicine at the Hull York Medical School, University of Hull.

This pioneering initiative aims to improve people’s asthma control to improve their outcomes, which in turn reduces the number of short acting beta agonist inhalers, commonly referred to as blue inhalers, needed by an asthma patient. Overuse of blue pressurised metered dose inhalers (pMDIs) have a large impact on the environment. So, improving peoples’ asthma control can therefore also be good for the environment.

Health Innovation Yorkshire & Humber has supported this initiative from the onset, encouraging its adoption across Yorkshire and the Humber, while exploring options for introducing a sustainable inhaler recycling scheme to further reduce the carbon footprint throughout the device’s lifecycle. This effort comes in response to growing concerns about the climate impact of inhalers, particularly due to the global warming potential of pMDIs. These devices contain hydrofluorocarbon propellants, which are potent greenhouse gases. Although inhalers are critical in managing respiratory conditions like asthma, their environmental impact is significant. This is not only due to the harmful gases they release but also the waste generated from plastics and metals when discarded in regular household refuse. In the UK alone, around 60 million inhalers are prescribed annually, accounting for roughly 3% of the NHS’s total carbon footprint, with pMDIs being responsible for most of this contribution.

Reducing environmental impact of inhalers without compromising patient care

Professor Mike Crooks and the SENTINEL PLUS initiative are at the forefront of addressing the environmental impact of inhalers by reducing the usage of short acting beta agonist inhalers in asthma, (which are usually pMDI devices) and promoting the Maintenance and Reliever Therapy regimen, which frequently involves dry powder inhalers (DPIs). DPIs don’t rely on harmful propellants and thus have a significantly lower carbon footprint. This makes DPIs a far more sustainable choice for managing respiratory conditions. SENTINEL PLUS also focuses on educating both healthcare professionals and patients about the benefits of switching to DPIs where clinically appropriate, while emphasising that the right inhaler for a patient is the one that they can and will use.

By prioritising a patient-centred approach, SENTINEL PLUS ensures that sustainability is achieved by improving patient outcomes and that any transition to greener inhalers is guided by both clinical needs and environmental considerations. This balanced approach helps reduce the environmental impact of inhalers without sacrificing the quality of patient care. Evidence from the prescribing strategy in Leeds, presented at the PCRS 2024 conference, powerfully demonstrates that introducing MART regimens can significantly reduce the carbon footprint of inhaler prescribing.

This approach is supported by the research from Lough et. al. (2024). Their survey of patients and healthcare professionals across more than 15 countries revealed that while the main preference for inhalers is clinical effectiveness, the next step should involve selecting the inhaler with the lowest environmental impact. They further supported the introduction inhaler recycling schemes.

Recycling inhalers supports NHS greener aims

Health Innovation Yorkshire & Humber is also advocating for better inhaler recycling schemes. Disposing of inhalers in regular waste contributes to both environmental pollution and lost opportunities for recovering valuable components. Recycling inhalers not only prevents harmful chemicals from entering the atmosphere but also allows for the reuse of materials such as aluminium and plastic.

In some areas of the UK, schemes like the NHS-led Re-Hale in Kent and the Leeds Hospital Inhaler Recycling Project in West Yorkshire have already been implemented, allowing patients to return used inhalers to pharmacies or acute care settings for proper recycling or disposal. While these schemes have demonstrated positive impacts, they can be costly and challenging to sustain over time. While traditional inhalers are generally easy to recycle, the latest DPI inhalers pose greater recycling challenges. To ensure long-term viability of these schemes, they must be scaled nationally to leverage economies of scale to reduce costs and facilitate a move from disposal to efficient recycling solutions for the latest DPIs.

The NHS has committed to achieving net zero emissions by 2040 and as future doctors are expected to consider the climate impact of medical treatments, initiatives like SENTINEL PLUS and Re-Hale are leading the way in showing how these ambitions can be done effectively while maintaining high standards of patient care.

Find out more about SENTINEL PLUS in our case study.

If you would like more information about these innovative solutions or how we can support the delivery of your innovation within the NHS, please contact info@healthinnovationyh.org.