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Researchers from Keele College have mentioned there are a number of obstacles stopping clinicians from prescribing different therapies for bronchial asthma sufferers, regardless of steerage calling for a transfer towards inhalers with decrease environmental affect.
Lack of clinician confidence and data round totally different inhaler system sorts, considerations about detrimental results on affected person care, and well being care system pressures are among the many obstacles to altering prescribing habits for bronchial asthma inhalers, the researchers have mentioned.
Using pressurized metered dose inhalers (pMDIs) for bronchial asthma therapy is regarded as one of many largest contributors to the NHS’ carbon footprint, with pMDIs making up 70% of inhalers prescribed within the UK, inflicting 3% of the NHS’s general carbon emissions.
Because of this, the NHS and the Nationwide Institute for Well being and Care Excellence (NICE) presently encourage well being care employees to supply lower-carbon alternate options corresponding to gentle mist inhalers and dry powder inhalers (DPIs) the place attainable, however till now there was little analysis into the components which have an effect on clinicians’ selections round which inhaler system sort to prescribe.
A brand new examine, revealed in BJGP Open by researchers from Keele’s Faculty of Medication, was the primary qualitative examine set in U.Ok. main care to discover the components influencing well being care professionals’ selections when prescribing inhaler gadgets, and the obstacles to decreasing pMDI use.
They interviewed 18 totally different clinicians concerned in inhaler prescribing, together with GPs, Observe Nurses, and Scientific Pharmacists, to study extra about their attitudes in the direction of decreasing pMDI prescriptions for bronchial asthma to scale back carbon emissions, and the sensible components which may forestall them from prescribing alternate options.
A variety of things have been recognized which prevented clinicians from decreasing pMDI prescriptions. Clinicians described basing selections totally on what’s “best” for the affected person, however underlying this was a hidden layer of influencing components together with clinician data and confidence (or an absence of), values, system and workload pressures, and assumptions primarily based on affected person demographics.
The researchers say these findings present a basis for serving to clinicians to prescribe decrease carbon inhalers, including that it’s going to take a number of totally different approaches at totally different ranges of the NHS to facilitate widespread change.
Lead writer Dr. Lauren Franklin mentioned, “This study explores the different facilitators and barriers to reducing pressurized metered dose inhaler prescriptions in general practice. For the NHS to reach its net zero targets, pMDI prescriptions need to be reduced. Understanding clinicians’ perspectives and how they make prescribing decisions is a vital step in reaching that goal.”
Dr. Helen Twohig, a GP and co-author of the examine, added, “This examine has highlighted the complexity of choices round inhaler system prescribing and the numerous affected person, clinician, and system degree components that have an effect on it. It has additionally recognized a broader want to enhance confidence and expertise in bronchial asthma administration in main care.
“A key message for clinicians and patients is that well-controlled asthma has the least environmental impact, so optimizing asthma control has benefits for patients and the environment; the two are not in tension.”
Extra info:
Lauren Franklin et al, Lowering pressurised metered dose inhaler prescriptions for bronchial asthma to scale back carbon emissions: a qualitative examine of healthcare skilled views, BJGP Open (2025). DOI: 10.3399/BJGPO.2024.0208
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Keele College
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