Assessment of Long-Acting Beta Agonists (LABAs)
We continue our journey to transform Respiratory care to the lowest possible carbon impact
by looking at LABAs this month. Chlorofluorocarbons (CFCs) inhaler propellants contained
in pMDIs (pressurised Metered Dose Inhaler) were recognised as ozone depleting substances
and were phased out in theUK by 1996.
CFCs were replaced by ‘CFC-free’ inhalers containing hydrofluorocarbons (HFCs). Although
HFCs are not ozone depleting substances, they are powerful greenhouse gases which can
contribute to global warming. Carbon emissions from inhalers have been assessed as being
responsible for approximately 3% of all NHS carbon emissions.
The NICE patient decision aid gives an indicative range for DPI (Dry Powder Inhalers) and pMDIs:
- DPIs (1 dose (two puffs)): 20 g CO2e per dose
- pMDIs (two puffs): 500 g CO2e per dose
This is, unfortunately, not the full story, as some pMDIs have a higher indicative carbon footprint
when compared with other pMDIs. Even though the Environmental Sustainability indicators have
been removed from the Investment and Impact Fund (IIF) 2023/24 Incentive scheme, there is still
a great need to reduce the carbon footprint of inhalers.
The choices available to swap MDIs to DPIs are limited with LABAs and the price differential may
deter some practices from changing to greener inhalers. It is also important to look at the number
of doses per inhaler as this may have an impact on the overall cost for a month’s supply. Dispex has
assessed the impact on profitability of all these possible changes and this information can be
accessed via the Brand Comparisons section of the Dispex website which is a Members’ only
Over the next few editions of the Gazette, Dispex will be looking at the Combination Inhalers, as well
as comparing Holding Chamber devices, as many patients will not be able to convert to a Dry Powder
Inhaler. We will be assessing the potential impact some of these might have on dispensary viability,
alongside the importance of the drive to ensure environmental sustainability. We will be offering
choices for dispensing practices and member practices can access the profitability impact of those choices.
Greener Practice, a Primary Care Group, has a wealth of resources to assist you in making changes
to more environmentally friendly inhalers as well as other resources which can help you make your
dispensary a beacon of sustainability. They welcome all members of primary care teams.