The National Asthma Council Australia (NAC) has released new information on today’s World Environment Day to help GPs make choices that could reduce asthma symptoms, prevent severe exacerbations and, at the same time, help improve the health of the environment.
Reducing the environmental impact of asthma treatment is the first statement from the NAC outlining why prescribing pMDIs has a much larger impact than other inhalers and practice points on how to minimise wastage while maintaining good asthma control.
Dr Brett Montgomery, Perth GP and member of the National Asthma Council Australia Guidelines Committee, said good asthma control and greener inhaler choices can go hand in hand.
“Better asthma disease control often leads to less use of inhalers that contribute to greenhouse gas emissions and that’s good for both patients and the planet,” he said.
“The new NAC information will help all health professionals to understand how poorly controlled asthma contributes to a larger carbon footprint in Australia through inappropriate or unnecessary prescribing, dispensing and purchase of inhalers.”
Dr Montgomery said it’s important to choose an appropriate device type for each individual patient, as good asthma control is the primary goal.
“The right device choice depends on many factors including age, dexterity, inspiratory ability and learning ability. For a large proportion of adolescents and adults, a dry powder inhaler, or soft mist inhaler, will be appropriate and avoid emitting the propellant gases of metered dose inhalers.”
“However, if a pMDI is genuinely the safest choice for a patient, we should not make people feel guilty about using their inhalers. This might make their disease control worse, which can be bad for people and the environment,” he said.
According to Dr Montgomery, the overuse of salbutamol pMDIs is the biggest concern.
“We know that a quarter of people with asthma in Australia have both poor asthma control and use little or no inhaled corticosteroids. Health professionals can help educate patients to understand that while short-acting beta2-agonists (SABAs) do give quick relief, they can if used on their own leave patients at risk of exacerbations, hospitalisation or worse.
“For many people with asthma who tend only to take their medicines when driven to do so by symptoms, swapping to an anti-inflammatory reliever strategy can be a positive change, and it is usually easy to change to a dry powder inhaler at the same time.
“Having a conversation with a patient can be an important opportunity for GPs to empower patients and show them that they can ‘go green’ with their inhalers and shrink their carbon footprint.”
Dr Montgomery said GPs can also make a greener choice, where appropriate, when commencing people on an inhaler for the first time.
“The first step before prescribing is to try to be sure that the diagnosis is correct, as there is evidence that overdiagnosis of asthma is common. Ideally, diagnosis should be confirmed with spirometry or other lung function tests.
“Then, if there is no special reason to choose a pMDI, a good option could be choosing a less polluting choice, which in asthma is usually a dry powder inhaler. Teaching the patient how to use their new device is important whichever device is chosen.
“Sometimes changing inhalers can offer other advantages, such as eliminating the need to use a spacer and some patients who are appropriate for anti-inflammatory reliever therapy (using budesonide-formoterol as their only inhaler) appreciate the simplicity of only using a single inhaler.
“When I prescribe this as GP, I know it is an effective treatment, and I also know it might reduce the carbon impact of their asthma therapy by more than 90%. This is partly through improving their asthma control and partly because pMDI salbutamol is replaced by a greener reliever,” he said.
Dr Montgomery said that some important work was being done in Australia in this space, primarily via the National Health and Climate Strategy, to improve respiratory health outcomes and reduce greenhouse gas emissions from respiratory inhalers.
