Delivering high quality, low carbon respiratory care

Promoting good respiratory care not only improves lung health outcomes for patients, but also reduces carbon emissions.

That’s why NHS England has been working in partnership with Asthma + Lung UK to help patients improve their lung health and support the environment with the provision of new information on inhaler choices.

By bettering inhaler technique and choice we can improve patient outcomes

More than 12 million people in the UK are currently affected by lung disease, and every year more than 60 million inhalers are prescribed as a key form of treatment.

However, outcomes for asthma patients in the UK lag behind those in other European countries, and evidence such as the National Review of Asthma Deaths and the 2022 Asthma UK patient survey shows that inhalers are not used in an optimal way, leading to poor outcomes and avoidable deaths.

As such, making sure that people with asthma, COPD, or other lung conditions are supported to use their inhalers as prescribed is of the utmost importance.

By doing so, patients can better manage their lung condition, meaning they will have fewer symptoms, helping them avoid an asthma attack or a flare-up of their lung condition and supporting them to stay well and out of hospital.

Supporting patients, supporting the environment

Inhalers account for 3% of the NHS carbon footprint, with most emissions coming from metered-dose inhalers (MDIs) due to the propellant (the gas carrying the medicine) within these inhalers.

As well as promoting better respiratory health, using inhalers correctly also has a positive environmental impact. By ensuring that patients are using their inhaler correctly, they will stay in better health and need fewer inhalers overall.

There is also an opportunity for patients and clinicians to follow in the footsteps of countries such as Sweden and increase the adoption of lower carbon inhalers.

More than 85% of patients and carers support the use of more environmentally friendly inhalers and moving to one of these can be done easily and safely, through a shared decision-making conversation with a healthcare professional.

Appropriately disposing of inhalers is another easy way to reduce our impact on climate change. Patients should be encouraged to take their used or expired inhalers to their local pharmacies, where they will be incinerated or recycled. These methods of disposal mean inhalers don’t go to landfill, where the leftover propellant would be released into the atmosphere.

High quality, low carbon respiratory care has the potential to prevent the equivalent of over 700 kilotonnes of carbon emissions in the NHS in England every year. That’s roughly the same as driving from London to Bristol 27 million times.

Resources to make the most of this opportunity

NHS England has been working with Asthma + Lung UK to help patients improve their lung health and support the environment with the provision of new information on inhaler choices.

Guided by input from clinicians, patients, and industry, we are supporting patients to:

  • use their inhalers as prescribed
  • adhere to the right inhaler technique
  • consider changing to a lower-carbon inhaler (via discussion with their healthcare professional)
  • return used or unwanted inhalers to their community pharmacy for appropriate disposal.

Several resources already exist to support high quality, low carbon respiratory care:

  • We have worked with The Royal College of GPs to develop a Net Zero hub with tailored educational courses and guidance.
  • NICE have produced an updated version of their patient decision aid to support inhaler choice.
  • Greener Practice (a clinician led network) provides support and guidance for health professionals who want to get involved.

Many GP practices and community pharmacies, including in Rochdale and Kidderminster, have already safely and effectively implemented these recommendations, to the benefit of both their patients and the environment.

Delivering on this opportunity will take a collective approach, from NHS colleagues to our partners and patients. To find out more and to get involved, please visit:

Emma Rubach, Head of Health Advice at Asthma + Lung UK said: “Produced in partnership with NHS England, our new information is designed for people with lung conditions who use inhalers, such as asthma and chronic obstructive pulmonary disease (COPD).

“We have conducted in-depth user research to understand how people feel about their inhalers and what motivates them to improve their lung health. We hope our resources will help people to manage their lung condition better and find the right inhaler for them.

“By managing their lung condition well, people who use inhalers can feel their best and help the environment at the same time.”

Dr Martin Allen is Interim National Clinical Director for Respiratory Medicine, GIRFT National Clinical Lead for Respiratory Medicine and National Specialty Adviser for Physiological Science.
Martin is also Consultant Respiratory Physician at the University Hospital of North Staffordshire, one of the largest respiratory departments in the country. He currently chairs the National Expert Group on Respiratory Coding and sits on the Royal College of Physicians Commissioning Advisory Group and the British Thoracic Society Board.