Health-care Resource Requirements and Potential Financial Consequences of an Environmentally Driven Switch in Respiratory Inhaler Use in England

Abstract

Background: To reduce greenhouse gas emissions, national initiatives advocate the phasing down of respiratory inhalers that use a fluorinated gas as a propellant (pressurised metered-dose inhalers [pMDI]). Nevertheless, pMDIs continue to be an effective and common choice. Objective: To assess the potential financial impact of patients with asthma or chronic obstructive pulmonary disease (COPD) switching from pMDIs to dry powder inhalers (DPIs) in a representative primary care network (PCN) population of 50 000 and the English National Health Service (NHS). Methods: Epidemiological data were combined with current inhaler use patterns to estimate the resources and costs associated with this transition, varying patient acceptance scenarios. Results: Depending on the approach, resource requirements ranged from £18 000 – £53 000 for a PCN, and from £21 – £60 million for the English NHS. Discussion: Significant funds are needed to successfully manage targeted inhaler transitions, together with counselling and follow-up appointment with an appropriately skilled clinician to assess the patient’s inhaler technique and ensure disease control. Conclusions: Targeted transition of inhalers must achieve a balance between environmental impacts, organisational factors, and patient requirements. The resources for managing a switch can be substantial but are necessary to appropriately counsel and support patients, whilst protecting the environment.

The Importance of Self-Management in the Context of Personalized Care in COPD

“…Furthermore, current incentive schemes within primary care networks need to be carefully implemented to ensure that device switching, eg for environmental reasons, is part of a fuller decision-making process in partnership with the patient – one that takes into account patient and healthcare resource requirements and resulting health impacts, as well as environmental impact. 65 …”

“…Furthermore, current incentive schemes within primary care networks need to be carefully implemented to ensure that device switching, eg for environmental reasons, is part of a fuller decisionmaking process in partnership with the patient -one that takes into account patient and healthcare resource requirements and resulting health impacts, as well as environmental impact. 65 Pharmacists with suitable training can also play an important role in patient self-care by promoting better health, prevention and early detection of disease, managing patients with long-term conditions and taking greater clinical responsibility for patients. 66 The introduction of a healthy living pharmacy framework can make a positive impact on community pharmacy services, enabling them to provide more services according to local need.…”

An EAACI review: Go green in health care and research. Practical suggestions for sustainability in clinical practice, laboratories, and scientific meetings

“…Significant funds are needed to successfully manage targeted inhaler transitions, together with counseling and follow-up appointments with an appropriately skilled clinician to assess the patient's inhaler technique and ensure disease control. 87 The very young, very old, and those undergoing an acute exacerbation still require pMDIs. The increase in the use and availability for more formulations delivered through SMIs might be a potential solution for these special populations.…”

Environmental impact of inhaler devices on respiratory care: a narrative review

“…(6,7) Iniciativas globais preconizam a redução gradual de dispositivos inalatórios que utilizam gases fluorados como propelente em inaladores pressurizados dosimetrados (IPD), uma vez que tais dispositivos estão associados a impactos ambientais significativos. (8) Três classes principais de dispositivos de terapia inalatória estão disponíveis para pacientes com asma e DPOC: IPD, inaladores de pó (IP) e inaladores de névoa suave (INS). (9) A pegada de carbono desses dispositivos inaladores é distinta, sendo mais intensa com os IDP que com os IP e INS.…”