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

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 (general practitioners, practice nurses and clinical pharmacists) 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 general practitioners, six practice nurses and four clinical pharmacists were interviewed. Results are presented over two topics. The first explores factors influencing inhaler device choice and discusses the 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 themes: understanding, attitudes to change, confidence in DPIs, engagement with sustainable prescribing, the role of incentives, and guidelines and systems.

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