Inhalers Resources

Asthma is an inflammatory condition which leads to narrowed and hyperresponsive airways. In recent times, the standard approach to managing asthma has been to use an inhaled corticosteroid (ICS, the preventer) to dampen down the inflammation and a short-acting bronchodilator (the reliever) to open up the airways if the person with asthma needed symptom relief. If the preventer inhaler is doing its job, the reliever should not be needed more than three times per week. The British Thoracic Society/Scottish Intercollegiate Guidelines Network guidelines currently reflect this approach (BTS/ SIGN, 2019), but later this year these guidelines will be updated based on a collaboration with the National Institute for Health and Care Excellence (NICE). NICE previously published its own asthma guidelines, which were controversial in terms of their recommendations, with a focus on using preventer therapy if a reliever was needed three times a week or more, rather than prioritising the use of anti-inflammatory treatment for an inflammatory condition. It will be interesting to see what the joint recommendations will be. In the meantime, many clinicians with an interest in asthma management are looking to the Global Initiative for Asthma recommendations for a fresh approach to asthma management (GINA, 2023).

An awareness of the impact of climate change has led to policies to reduce greenhouse gas emissions (GHGEs). The National Health Service (NHS) is the UK public sector’s largest emitter of greenhouse gases, with a target to deliver a net zero NHS by 2050 (NHS, 2020). Pressurised metered dose inhalers (pMDIs), which use hydrofluoroalkanes (HFA) as the propellant, have been targeted as a perceived easy option to reduce the NHS carbon footprint of HFA, as alternative inhaler devices in the form of dry powder inhalers (DPIs) and soft mist inhalers (SMIs) which contain no propellant are readily available. Balancing the environmental impact while ensuring that the best option of inhaler device is provided for individual patients can lead to conflict and confusion for healthcare professionals while waiting for manufacturers to provide pMDI with propellants that are more environmentally friendly. This article discusses sustainability, from manufacture to disposal.

Salbutamol is the most widely prescribed bronchodilator belonging to a class of drugs known as beta-2 adrenoceptor agonists, more commonly known as short-acting beta agonists (SABA). Their role is to relax airway smooth muscle (ASM), thereby reducing symptoms of wheeze, shortness of breath or cough in airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). Salbutamol is generally regarded as a safe medication when used correctly. This article looks at the history of this class of medications, how they work at a cellular level, and the associated risks if they are overused or incorrectly used. It includes a discussion on the most commonly used SABA-containing device — the pressurised metered dose inhaler (pMDI). An understanding of the clinical and potential cellular effects of overuse will be discussed in the context of associated risks, as well as discussion on the drive to reduce greenhouse gases to care for the planet, and how this can be achieved while providing best care for patients 

The environmental impact of healthcare delivery in general, and respiratory-related healthcare specifically, has gained increasing attention in recent years. Reducing national carbon emissions and improving sustainability has become a high priority both at governmental level and for the NHS across the UK. General practice nurses (GPNs) have a critical role to play in addressing the environmental impact of respiratory healthcare. While the priority must always be to do the right thing clinically for individual patients, there are a range of strategies which can be introduced to day-to-day practice to reduce the carbon footprint of respiratory healthcare. This article reviews a range of strategies from protecting and improving the indoor air quality of healthcare facilities and ensuring patients understand and use their prescribed medications effectively, to undertaking a quality improvement initiative to address environmental issues. Integrating sustainable healthcare principles in every aspect of clinical practice can drive the delivery of greener respiratory healthcare that will benefit us all without detriment to delivering high quality care.

With so many new inhaled therapies available for treating asthma and chronic obstructive pulmonary disease (COPD), how does the busy healthcare professional make a prescribing decision which is safe and effective?