P187 Ease of use, effectiveness and environmental impacts: Evaluating inhaler prescriptions, patient preferences and opportunities for improvement

Improving respiratory care is good for patients and good for the planet. Inhalers contribute 4% of the NHS’s carbon footprint. The NHS committed to 51% carbon emissions reduction by 2025 (on 2007 baseline). The carbon footprint of dry powdered inhalers (DPIs) is 8gCO2eq/dose. Metered dose inhalers (MDIs) have 10 times this footprint (82–119gCO2e/dose). Methods We designed scoring systems to assess DPI and MDI technique (image). We developed a survey to assess patients’ inhaler prescriptions, technique and preferences. We piloted and amended the survey twice to improve coherence and clarity; then surveyed twenty respiratory ward inpatients over six weeks. Results 20/20 patients were prescribed both MDI and DPI, but some did not have both inhalers at their bedside. DPI 16/20 had a DPI at the bedside. 14/16 felt very confident or confident using the DPI, 2/16 somewhat or not confident. 13/16 remembered being shown how to use their DPI. Checking DPI technique, out of 5 points: 8/16 scored 5, 3/16 scored 4, 3/16 scored 3, 2/16 scored 2. MDI 17/20 had an MDI at the bedside. 13/17 felt very confident or confident using the MDI, 4/17 somewhat or not confident. 15/17 rememberd being shown how to use their MDI. Checking MDI technique, out of 4 points: 5/17 scored 4, 4/17 scored 3, 8/17 scored 2. 9/17 patients lost a point due to not using a spacer. 9/17 patients said they use a spacer. 4/9 find cleaning a spacer inconvenient. 3/9 find carrying a spacer inconvenient. Recycling 11/17 said they know when their MDI needs replacing. 6/17 automatically receive an MDI on every prescription. 5/16 automatically receive a DPI on every prescription. 4/20 knew that they could return inhalers to pharmacies for recycling. 6/20 knew that inhalers should not be put in council recycling bins. Preferences 16/20 would be willing to change inhaler for one that is easier to use. 20/20 would change for increased effectiveness. 16/20 would change for lower carbon footprint. Discussion Potential improvements in respiratory disease management include switching from mixed DPI/MDI to DPI-only prescriptions, and demonstrating and checking inhaler technique. The survey tool is available from sarah.walpole@doctors.org.uk