Go Greener: Assessment of Long Acting Anti-Muscarincs (LAMAs)

By Dr Philip Koopowitz- Dispex & Hexagon6

We continue our journey to transform Respiratory care to the lowest possible carbon impact by looking at LAMAs this month. Chlorofluorocarbons (CFCs) inhaler propellants contained in pMDIs (pressurised Metered Dose Inhaler) were recognised as ozone depleting substances and were phased out in the UK 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.

All LAMAs are available as either Dry Powder inhalers or Soft Mist Inhalers and their Indicative Carbon foot-print per 28 days ranges from 723 down to 86. You will notice that the lowest carbon footprint is related to the refill capsules.

Practices are encouraged to issue refills as their default and issue a new device every 6 months. 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 resource.

The profitability comparisons include figures on the website showing the profitability of prescribing generically and dispensing a particular brand, which can make a significant difference between dispensing at a loss and ensuring your dispensary viability.

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 https://www.greenerpractice.co.uk/