Reducing pressurised metered-dose inhaler prescriptions for asthma to reduce carbon emissions: a qualitative study of healthcare professional perspectives.

Abstract

Background: Prescribing of pressurised metered-dose inhalers (pMDIs) is a key NHS carbon hotspot and reducing the number of these devices prescribed will help achieve NHS net zero targets.

Aim: To explore primary healthcare professionals' perspectives on reducing the prescribing of pMDIs for people with asthma to reduce associated carbon emissions.

Design & setting: Qualitative study of healthcare professionals (GPs, practice nurses [PNs], and clinical pharmacists [CPs]) working in general practice in England.

Method: Eighteen semi-structured interviews were conducted with healthcare professionals. Participants were recruited through professional networks and using snowball sampling. Topic guides were developed to explore participant perspectives, concerns, and motivations.

Results: Eight GPs, six PNs, and four CPs were interviewed. Results are presented over two topics. The first explores factors influencing inhaler device choice and discusses the following themes: patient-centred care; bias and assumptions; clinician confidence and knowledge; and status quo of asthma care. The second topic identifies facilitators and barriers for prescribing fewer pMDIs through the following themes: understanding; attitudes to change; confidence in dry powder inhalers (DPIs); attitudes to change; engagement with sustainable prescribing; and system drivers.

Conclusion: Interlinking personal, consultation, and external factors influence which inhaler device is prescribed for patients with asthma. There are considerable actionable barriers to implementing carbon-conscious prescribing, many of which would improve the quality of asthma care.