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A Pilot Study to Raise Awareness of the Carbon Footprint of Inhaler Prescriptions in French Primary Care.
ABSTRACT
Background:
Climate change is expected to cause over 250,000 deaths annually by 2050 and could increase the prevalence of asthma and COPD by up to 30%. Pressurized metered-dose inhalers (pMDIs), primarily delivering Short-Acting Beta-2 Agonists (SABA), generate 15–30 times more greenhouse gas emissions than dry powder or soft mist inhalers. In France, SABA pMDIs account for 95% of reliever therapy prescriptions, despite their limited effectiveness in controlling the disease.
Objective:
The main objective of this pilot study is to assess the impact of an eco-responsible intervention aimed at reducing the prescription of high-carbon-impact among general practitioners in primary care.
Methods:
We conducted an open-label, non-randomized, multicenter formative pilot study with 34 general practitioners from 10 multi-professional health centers (March–October 2023). The intervention was a 25-minute face-to-face training session on environmentally responsible inhaler prescribing, aligned with GINA and GOLD guidelines. Pre- and 3-month post-intervention online questionnaires assessed prescribing patterns, knowledge, and satisfaction.
Results:
Self-reported pMDI use in reliever therapy decreased from 75% to 4% (P < .001), and in maintenance therapy from 21.3% to 4.4% (P = .003). Adherence to GINA guidelines improved, reflected by an increase in ICS–Formoterol prescriptions for reliever therapy (6% to 38%, P = .001) and maintenance therapy (35% to 56%, P = .016). No significant improvements were observed for COPD. Environmental impact became a factor in prescribing decisions for 51% of participants, compared with 3% at baseline. Participant satisfaction was high, with 93% reporting being “very satisfied,” and 80% indicating a moderate to strong influence on their clinical practice.
Conclusions:
A short, practice-focused educational intervention proved feasible and well-received, and it was linked to decreased self-reported prescribing of pMDIs for reliever therapy, reduced use of pMDI SABA, and improved adherence to asthma guidelines. Findings support the scalability of this approach and justify a cluster-randomized trial with objective prescribing data and longer follow-up. This pilot study is encouraging, but caution is needed when changing inhalers in older adults, as some warning signals have been highlighted in recent research. Therefore the transition between inhalers should be carried out in an individualized manner, based on clinical evidence base-medicine and ensuring the safety and effectiveness of treatment for each patient. Clinical Trial: no
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