Driving Sustainability in Asthma and COPD Management: Preventative Models and Green Prescribing in a Rural Primary Care Practice in England.

Background: Asthma and COPD are among the most prevalent chronic respiratory conditions, with inhalers as their primary pharmacological treatment. In the UK, metered-dose inhalers (MDIs) account for 70% of all inhaler prescriptions and contribute significantly to the NHS's carbon footprint, making green prescribing a critical focus. Aligning environmental sustainability with clinical excellence is essential to reducing exacerbations and deaths while minimising carbon emissions.

Objective: This initiative aimed to assess the localised impact of a structured quality improvement program designed to enhance respiratory care and integrate sustainable prescribing practices. Specifically, it sought to evaluate prescribing patterns, respiratory review completion rates, and the feasibility of transitioning patients from MDIs to lower-carbon alternatives whilst maintaining clinical outcomes.

Methods: The initiative, implemented at a UK general practice in January 2020, focussed on staff education, restructuring respiratory consultations, and patient engagement. The "treatable traits" paradigm and best practice frameworks guided the program to optimise individualised care. Prescribing data, in-date respiratory review rates, and estimated carbon emissions were analysed over 4 years (2020-2024) using publicly available sources such as OpenPrescribing.net. While education was a component of the intervention, no formal assessment was conducted on its direct impact on prescribing behaviours.

Results: The practice achieved an in-date respiratory review rate exceeding 90%, rising to over 96% during the most recent QOF period. Over 4 years, the proportion of non-salbutamol MDI prescriptions decreased from 62.9% to 36.2%, aligning with national sustainability goals. Despite growth in the practice population, overall carbon emissions from inhalers were successfully reduced, reflecting a shift towards lower-carbon prescribing.

Conclusion: This initiative illustrates the feasibility of integrating sustainable prescribing practices into routine respiratory care, aligning with the goals of the national health system. This work highlights the potential of local-level interventions to contribute to broader sustainability efforts in respiratory medicine. Improvements in prescribing patterns and review rates have been noted, but more research is needed to evaluate the impact of educational interventions on healthcare providers' and patients' decisions. Future initiatives should focus on structured evaluations of long-term adherence and clinical outcomes.