ArticleJournal of the Royal Society of Medicine2023
Temporal and geographical variation in low carbon inhaler dispensing in England, 2016 to 2021: an ecological study.
Article in Journal of the Royal Society of Medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- Strategies and tactics to reduce the impact of healthcare on climate change: systematic review.BMJ (Clinical research ed.) · 2024Pooled it
- Estimation of carbon emissions from inhaled respiratory medicines in Ireland: a cross-sectional study from a national pharmacy claims database from 2020 to 2022.International journal of clinical pharmacy · 2026Article
- Using OpenPrescribing.net to evaluate neighbourhood-level prescribing of inhalers for asthma and COPD.Scientific reports · 2025Article
- Medicinal Products and Environmental Pollution.Pharmaceutical medicine · 2024Article
- Fixing the NHS with public health and public engagement.Journal of the Royal Society of Medicine · 2023Article
- Unequal Access, Unequal Outcomes: Analyzing Chronic Obstructive Pulmonary Disease Hospital Admissions Across Clinical Commissioning Groups.Open respiratory archivesArticle
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesIn 2019-2020, four national recommendations were published in the United Kingdom to encourage use of low carbon inhalers. This study aimed to investigate whether these were associated with a change in primary care dispensing in England and to explore associations between geographical variation and clinical commissioning group (CCG) characteristics.
designEcological study using aggregated publicly available data.
settingAll CCGs in England (March 2016 to February 2021).
participantsnot applicable.
main outcome measuresPercentage of low carbon inhalers dispensed.
resultsThe percentage of low carbon inhalers dispensed was 26.3% in 2020-2021 (of 8.8 million inhalers). This decreased over the study period for short-acting beta-agonist (SABA), inhaled corticosteroid (ICS) and ICS+long-acting beta-agonist (LABA) inhalers. The same trend was seen for LABA and ICS+LABA+long-acting muscarinic antagonist inhalers from 2019. The SABA and ICS classes were less often dispensed as low carbon inhalers (⁓6% versus 35-45%). Interrupted time series analyses found slight increases in low carbon inhaler percentage in the SABA, LABA and ICS classes after April 2019, which were soon erased by the long-term trend. There was also geographical variation, with the north-west, Birmingham and London consistently dispensing more low carbon inhalers. The presence of advice on climate change in CCG formularies/guidelines, the prevalence of asthma and population age profile were associated with significant variation in low carbon inhaler percentage for some classes.
conclusionsThe percentage of low carbon inhalers dispensed in England remains low and continues to decrease. Greater use of low carbon inhalers is achievable, but is more likely with locally implemented initiatives.
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