If you are on social media and follow some people in the asthma world you will see that this seems to be a big topic. You will also more than likely see this image:
The humble Ventolin Evohaler pMDI (pressurised metered dose inhaler) or puffer is taking a huge amount of flack for the carbon footprint it is leaving behind. I am frustrated at the tweets and posts on social media that say we need to change and stop prescribing it and should prescribe a dry powder inhaler (DPI).
There are so many more questions that need to be asked and addressed before we just stop prescribing it (the questions below are in no particular order)
- Why are there being so many ventolin prescriptions issued?
- Does the patient have a spacer device to use and are they using the spacer device when taking their inhaler?
- Has the patient had an annual asthma review?
- Has the patient had their inhaler technique checked?
- What preventer medication is the person on?
- Are they taking the preventer medication as prescribed, if not why not?
- Has the patient had adequate asthma education?
- Does the patient have a Personal Asthma Action Plan (PAAP) to follow if their asthma is getting worse?
- Does the patient need referred on to secondary care for further assessment and treatment of their asthma?
- Has the patient seen the different types of inhalers available to them and been able to ask questions?
- Has the patient been assessed to make sure they can take their preventer medication properly for example do they have a strong enough inhalation for a dry powder device?
- Have all household elements been discussed such as making sure no one smokes inside the residence so there is trigger reduction?
As you can see this is a long list and it is not extensive there are so many other questions too.
What frustrates me most is that the push is all wrong. Climate change is a big issue just now so anything that can be done to reduce a carbon foot print is essential but the press are missing the big picture. There are so many ways to reduce a carbon footprint and keep people in inhalers they like and are used to.
Asthma care needs to be improved and the fundamentals changed this would reduce the use of ventolin evohalers and therefore reduce the carbon footprint.
What the media fails to identify and explain is the reason why there is such a huge use of ventolin evohalers. Ultimately money needs to be invested in giving patients time with their asthma nurse because the time they are allowed is never enough to answer all the questions and address any issues patients may have.
Social media is also full of clinicians and pharmacists saying we need to change inhalers or patients need to be more adherent but no one is asking patients what they want. There is no choice given to patients about what inhalers they want and what regimes would suit them. It is all down to the healthcare practitioner or local guidelines.
Over my lifetime I have had several situations where I have been taking more ventolin and not taking my preventer. One such time was because I did not get on with the device I was given and the regime. It was a dry powder device which I had to take 3 times a day. At the time I was at a day school and in upper primary. I was not allowed to keep my inhalers on me. So at lunchtime I would have to go to the nurses office, often had to wait for her to be there at which point my classmates were all in lunch and I was left waiting for the nurse. So I just stopped going to the nurse’s office and skipped my lunchtime dose because I wanted to have lunch with my class mates and friends. I would often have to wait so long for the nurse my friends were finished lunch by the time I got to the lunch hall. So because of this I needed more of my ventolin as my asthma became more uncontrolled.
I was also given a dry powder device which when my asthma was bad I found really hard to use and get a good breath in but I would also end up coughing so much due to the powder hitting the back of my throat so once again this was a reason I stopped taking my inhaler. Also when having an acute attack using the dry powder device was so difficult, I couldnt get the medication in so was using more of it. I didnt have great asthma education back then so I didnt know how the preventer inhaler worked and why it was not great to rely on your reliever inhaler.
There was also another time when as a child some of my friends had a different inhaler and I wanted this one. I am sure as a child if you had the same as others you are more likely to use it because of that.
If I had these issues as a child I am sure there are many others that do as well. I know I have never actually been asked what type of inhaler device would suit me and what regime would fit in with my day to maximise the likelihood of me taking every dose as I am meant to (I do take all my treatment as prescribed because I understand how they work and why it is important).
Patient choice is so important but it is often not given and the issue around carbon foot print is just the same. In asthma care just now there are far more important questions to answer and address before highlighting the carbon footprint an inhaler has.
I always carry my ventolin (pMDI). It fits nicely in my pocket. I have to hold my hand up and say I am guilty of not always using a spacer device because I don’t carry a bag and it doesn’t fit in my pocket. If there was a pocket sized spacer device I would carry it too. I was once in a meeting with a group of Dr’s and was horrified and angered when I was told I should just start taking a bag if the inhaler I was prescribed didnt fit in my pocket. I could not believe this. The choice of device out there should allow you to make a choice about what fits with you. I don’t want to have to change how I go out and about because of a inhaler I have been given that is not what I wanted. Ultimately that would be more dangerous because I would probably forget to take a bag because I have never been someone who carries a bag- everything goes in my pockets, so I would then end up without an inhaler completely which if I was to have an asthma attack would create a bigger carbon footprint because there would need to be an ambulance called, the use of a lot of single use medical devices and equipment (plus the packaging), the the trip going to hospital, staying in hospital and getting home from hospital all which add to my carbon footprint. So looking at this what is the bigger culprit to my carbon footprint?
Fundamentally if asthma patients are given time to be educated about their asthma, have conversations about the medications and how they work along with the different devices they come in, then a choice can be made. Having all these tools will allow the patient to live better with their asthma, become less reliant on their ventolin inhaler and as a result they will not need as many prescription for inhalers so less will be in use therefore reducing the carbon footprint.
It is unfair to be making patients feel guilty about their inhaler use when they are not given the correct tools to enable them to reduce the amount they need inhalers which can contribute to a higher carbon footprint.