Environmentally friendly inhaler decision-making with personalized care in asthma and chronic obstructive pulmonary disease: a qualitative study

Background

Green behavioral shifts in prescribing habits, device selection and patient counseling have been proposed to deliver low-carbon sustainable healthcare, including the transition from pressurized metered-dose inhalers (pMDIs) to propellant-free inhalers.

Objective

This study explores the extent to which healthcare professionals (HCPs) and patients can factor the environmental impact into inhaler decision-making with personalized care in asthma and chronic obstructive pulmonary disease (COPD).

Methods

An exploratory qualitative study was conducted involving seven focus groups and one semi-structured interview with 22 participants consisting of general practitioners, community pharmacists, pulmonologists, assistants and patients. Data was analyzed deductively to identify challenges and facilitators related to capability, opportunity and motivation; and inductively for actions to foster environmentally conscious behavior.

Results

Overall, participants felt a moral responsibility and were willing to opt for environmentally friendly inhaler initiatives including a shift from pMDIs to dry-powder inhalers (DPIs), if clinically appropriate and performed as outcome of shared decision-making. Collaboration between researchers and relevant stakeholders was required to strengthen their capacity to advance in this area. Proposed strategies covered five areas: (1) communication, education and awareness; (2) appropriate inhaler prescribing; (3) promotion of smarter inhaler choices; (4) optimization of quality of care; and (5) appropriate inhaler disposal.

Conclusion

These findings guide the delivery of a range of opportunities to improve quality of care while simultaneously reduce carbon footprint. This requires a multifactorial and interdisciplinary approach with HCPs playing a central role in engaging and educating patients to determine the viability of environmentally friendly alternatives, promote correct inhaler use and appropriate disposal.