Improving respiratory (Asthma and COPD) outcomes for patients and reducing the environmental impact of inhalers.

Published on 8 August 2022

About the project

The NHS has a national ambition to deliver the world’s first net zero health service and respond to climate change, improving health now and for future generations.

Inhalers account for 3% of the total NHS Carbon footprint. Salbutamol metered dose inhalers (MDIs) are the single biggest source of carbon emissions from NHS medicines prescribing[i]. Dry powder inhalers (DPIs) and other newer types of inhalers like soft mist inhalers are less harmful to the environment than traditional metered dose inhalers (MDIs).

Patients in the United Kingdom experience poorer outcomes in terms of respiratory disease in comparison to comparable countries. Why Asthma Still Kills reports that high use of short acting beta agonists (salbutamol and terbutaline) and poor adherence in the use of inhaled corticosteroids in asthma suggests poor control, and these patients should be reviewed regularly to ensure good control[ii]. The UK has a higher rate of short acting beta agonist (SABA) overuse than other European countries which is associated with an increased risk of exacerbations and mortality[iii].

The 2022-2023 Investment and Impact Fund (IIF) includes targets to improve respiratory outcomes for patients alongside improving the environmental impact of inhalers. The two targets for improving the environmental impact of inhalers are; prescribing salbutamol products with lower carbon emissions and improving the proportion of non-salbutamol MDI’s prescribing to being only 25% by 2023/2024 which will bring England in line with best practice in other European countries.

[i] Network Contract Directed Enhanced Service Investment and Impact Fund 2022/23: Updated Guidance March 2022


[iii] Janson C, Menzies-Gow A, Nan C, Nuevo J, Papi A, Quint JK, Quirce S, Vogelmeier CF. SABINA: An Overview of Short-Acting β2-Agonist Use in Asthma in European Countries. Adv Ther. 2020 Mar;37(3):1124-1135. doi: 10.1007/s12325-020-01233-0. Epub 2020 Jan 24. PMID: 31981105; PMCID: PMC7089727.

Project ambitions

Successful delivery of work to improve the environmental impact of inhalers will seek to:

  • Reduce reliance on short acting beta agonist inhalers (Reliever inhalers)
  • Increase the use of Inhaled Corticosteroid Inhalers (Preventer inhalers)
  • Increase use of inhalers that have a greener footprint
  • Improve outcomes for patients with respiratory disease
  • Significantly reduce the environmental impact and carbon emissions of inhalers

Get Involved


HIWM are supporting Primary Care Networks across the West Midlands in implementing Quality Improvement projects that support high quality respiratory care alongside seeking to improve the environmental impact of inhalers.

Part of our work is looking to provide upskilling resources and confidence in Maintenance and Reliever Therapy (MART).

We are currently seeking PCN’s to trial quality improvement projects within toolkits. If you are interested in improving environmental impact or in getting involved, please contact

Hereford and Worcester

Improving environmental sustainability and asthma care. Healthier Futures- Greener NHS

HIWM is supporting and evaluating a successful NHS Healthier Futures bid with Alastair Jackson of Wyre Forest Health Partnership and Herefordshire and Worcestershire ICS.

This series of four online meetings aims to support practices in delivering the respiratory and sustainability elements of the investment and impact fund safely and effectively whilst at the same time improving asthma care.

It has the further goal of providing information about sustainability in primary care and how we can move towards the NHS’s Net Zero goals.

Finally, it aims to build a network across primary care in Herefordshire and Worcestershire to facilitate sharing of good practice in relation to sustainable primary care.

This is a series of four meetings with funded places for a limited number of primary care clinicians (GP’s, pharmacists and respiratory nurses) from each PCN across Herefordshire and Worcestershire, though unfunded places will be available to all. Funding has been provided as a result of a bid to the Healthier Futures Action Fund.


Project team

Anna Edwards

Innovation Project Manager: Medicines and the Greener NHS

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