Introduction:
The NHS aims to achieve net zero carbon emissions by 2040, with an interim target of an 80% reduction by 2028-2032. Inhalers contribute significantly to the NHS carbon footprint, particularly pressurised metered-dose inhalers (pMDIs), which use hydrofluorocarbon (HFC) propellants—potent greenhouse gases. The aims of this study were to optimise asthma care in a primary care practice to reduce inhaler-related emissions through patient education, sustainable prescribing practices, and proper inhaler disposal.

Methodology:
An asthma audit was conducted on 210 patients who were prescribed inhalers. Between August and October 2023, practice nurses and clinical pharmacists reviewed patients, emphasising low-carbon inhalers and proper inhaler techniques. Patients received educational materials, including video links and SMS campaigns, promoting environmentally conscious inhaler disposal. Prescribing practices were evaluated using data from Open Prescribing, with targets to reduce pMDI prescriptions below the national median and lower the carbon impact of salbutamol inhalers.

Results:
Following the intervention, 41% of patients were using low-carbon inhalers, an increase from 27%. However, 22% of patients declined switching, citing concerns about asthma control. Awareness of proper inhaler disposal was initially nonexistent but improved modestly post-intervention. The practice reduced pMDI prescriptions to 46%, surpassing the national median, and maintained a lower-than-average carbon impact per salbutamol inhaler.

Conclusion:
The project demonstrated modest success in transitioning patients to low-carbon inhalers and raising awareness of sustainable inhaler disposal. Continued education for clinicians and patients, along with shared decision-making, is crucial to overcoming resistance and maximising environmental and health benefits. Future efforts should include virtual group consultations and expanded patient outreach to further drive sustainable respiratory care.

Keywords: Development, Quality Improvement, Sustainability.