Greener Asthma Prescribing – a research proposal

Talk Code: 
Helen Twohig
Twohig, H1, Bansal A2, De Simoni A3, Jackson T4, Murphy A5, Pooler A1, Swinglehurst D3, Taylor SJC3, Mallen CD1
Author institutions: 
1. Keele University 2. GP and co-founder of Greener Practice 3. Queen Mary University of London 4. PPI lead AUKCAR, Edinburgh University 5. Consultant respiratory pharmacist, De Montford University, Leicester


Climate change is the single greatest threat to human health. One of the ‘hotspots’ identified by NHS England to target to reduce carbon emissions is prescribing of pressurised metered dose inhalers (pMDIs). pMDIs contain potent greenhouse gases as propellants. Prescribing of these devices accounts for 3-4% of the entire NHS carbon footprint. Ways to reduce pMDI prescribing include tackling over-reliance on short acting beta agonists (‘reliever’ treatments), optimising inhaler technique and switching to dry powder inhalers (DPIs), which have lower global-warming potential.

Despite there being policy targets to reduce pMDI prescribing and clinical guidance to support greater use of DPIs in asthma, there is little evidence to support implementation of this guidance and realisation of these targets in primary care.


To explore patient, health care professional and commissioner perspectives on reducing prescribing of pMDIs for people with asthma to reduce the carbon footprint of primary care, and to lay the foundations for future interventions to achieve this.

The Approach

Focus groups will be held with people with asthma, GPs, practice nurses and practice pharmacists. Individual interviews will then be carried out with additional participants from each professional group and patients to explore themes and ideas arising from the focus groups.

Topic guides will be developed with input from our PPIE group and iteratively modified as the study progresses.

Thematic analysis will run concurrently with data collection to test emerging and discordant themes, both within and across groups.  Theoretical frameworks relevant to behaviour change and intervention development will be drawn upon and coding will be refined through discussion with the multidisciplinary research team. 

Anticipated impact

This research will provide insights into how inhaler choices are made, patient and professional understanding of the environmental impact of inhalers and how this influences decisions, and barriers and facilitators to switching to DPIs.

Findings will be used to develop interventions to reduce the prescribing of pMDIs, therefore reducing the carbon footprint of primary care.


Funding acknowledgement: 
Helen Twohig is funded by a Wellcome Trust Primary Care Doctoral Fellowship