Prescriber Attitudes Towards Prescribing 'Green' Inhalers in Secondary Care.

Introduction The climate emergency is advancing at a rapid rate and affecting every corner of the globe. Healthcare has been calculated to be responsible for a considerable part of global greenhouse gas (GHG) emissions. Dry powder inhalers (DPIs) are a lower-carbon alternative to pressurised metered dose inhalers (MDIs); however, many patients remain on MDIs. This study aimed to identify barriers to switching to DPIs, as a trust-wide audit of pressurised MDIs (pMDIs) revealed that very few of the patients eligible for a DPI were offered it in secondary care, despite sustainability initiatives. Methods We conducted interviews focusing on the perceptions and experiences of secondary care healthcare professionals (HCPs) relating to inhaler prescribing. Potential participants were selected through purposive sampling to ensure a broad perspective. Semi-structured interviews were conducted, and their transcripts were coded using QSR NVivo (Burlington, MA). Qualitative data were organised and analysed thematically using the framework method. Results Nineteen participants were recruited from varying grades and disciplines within secondary care. Three themes relating to attitudes towards sustainable inhaler prescribing emerged: 1) the awareness of suitable inhalers, 2) knowledge and 3) making an impact. Conclusion  HCPs indicated a desire to reduce the carbon footprint generated by healthcare. However, the poor awareness of the inhaler carbon footprint acted as a barrier to promote sustainable inhaler prescribing. Where participants were aware of their carbon footprint, a lack of knowledge and confidence regarding inhalers prevented a change to sustainable inhalers. Overall, this study shows that existing sustainability initiatives are not delivering the intended impact and that more work is required around raising awareness and education regarding inhalers.