Summary of recommendations for environmental considerations of respiratory prescribing

  • Promotion of person-centred reviews to optimise disease control and ensure quality prescribing in line with national guidance
  • Prioritise review of patients with asthma who are over-reliant on SABA reliever inhalers as a marker of poor asthma control (see Asthma)
  • Streamline devices for patients, avoiding multiple device use where possible
  • Review separate inhalers where a combination inhaler device would be possible
  • Review individuals prescribed SABA alone, check diagnosis and if appropriate consider a low GWP inhaler
  • Update local formularies to highlight and promote inhalers with lower CO2 emissions 
  • Use ScriptSwitch in GP Practices to promote better asthma care and environmental messages e.g.
  • Highlighting SABA overuse
  • Prescribe low volume cannister Salbutamol pMDI with lower GWP
  • Raise public awareness to promote good asthma care and the environmental impact of respiratory prescribing
  • Utilise resources to support patients and clinicians in environmentally friendly and sustainable prescribing (see Resources for patients and clinicians)


For new patients

  • Use inhalers with low global-warming potential where they are as equally effective
  • Where there is no alternative to a pMDIs, lower volume HFA 134a pMDIs should be used in preference to large volume or HFA 227ea pMDIs


For existing patients

  • Switch to DPI or SMI if appropriate, following a patient review. We do not recommend a blanket switch
  • Consider switch to DPI inhalers for patients with asthma who are interested and: have an adequate inspiratory flow. If there is concern regarding inspiratory ability due to age or frailty, it can be checked using an inspiratory flow device, such as placebo whistles or In-check® device