Quality prescribing strategy for respiratory conditions in Scotland: improving patient care and promoting environmental sustainability.

Objectives: The respiratory prescribing strategy previously published by the Scottish Government did not include any environmental sustainability information and required updating to incorporate this. It was recognized that ~3% of the carbon footprint of NHS Scotland results from the use of pressurized metered dose inhalers due to the high global warming potential of inhaler propellants. The aims of the guide were to support clinicians and people with respiratory illness in the appropriate use of medicines, while applying the principles of value-based health care and realistic medicine, including environmental sustainability. Person-centred medication review, including optimising appropriate inhaler use, is promoted using the 7-step methodology described in the Scottish polypharmacy guidance.

Methods: Stakeholders, including people with lived experience, third sector patient organizations and multidisciplinary team representatives from across primary and secondary care were invited to update the respiratory guide. Open consultation was undertaken before publication. Tools and resources to assist in implementation of the recommendations were developed, including data and patient facing resources.

Key findings: The 'Quality Prescribing Strategy for Respiratory Conditions: a guide for improvement (2024-2027)' was published by the Scottish Government in April 2024. It highlights key recommendations for respiratory prescribing, to improve care of people living with respiratory conditions and to reduce environmental impact of respiratory care.

Conclusions: The guide supports the implementation of national UK-based guidance, including the Scottish Intercollegiate Guidelines Network and National Institute for Health and Care Excellence guidance, together with the indicators and tools to drive improvement in prescribing and patient care by assisting clinicians with practical guidance and prescribing resources. It also supports healthcare organizations and sustainability committees to prioritize actions.