What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Asthma affects 1 in 11 people in the UK.

Children and adults with asthma rely on inhalers to keep their asthma controlled and treat flare ups. In the UK, most people use puffers (pressurised metered dose inhalers) to treat their asthma. However, patients, carers and people who help look after individuals with asthma don’t know enough about puffers.

Puffers still puff when the medicine is gone.

Inhalers will ‘puff’ for 60-70 times after the medicine is gone.

Puffers contain powerful greenhouse gases.

This propellant has a significant impact on climate change. Returning puffers to pharmacies allows safer disposal, limiting their climate impact.

A survey of n=508 asthmatics shows the scale of the problem.

The answer is better cross-sectoral education.

We have launched the ‘count it out’ campaign. This is assisted with cheap monitoring devices. We want to work across system boundaries with schools and pharmacists to amplify these messages and measure our impact.

What does your project aim to achieve?

Objective 1. Reduce salbutamol usage and waste 

In the UK, we use an astonishing 30 million salbutamol puffers annually. 36% are disposed of with more than half the doses unused.

By teaching children, parents and carers how their inhalers work and how to know when they are empty (or not) we hope to reduce the number of puffers used in our communities.

Objective 2. Reduce healthcare utilisation

This will also keep our patients safer, and reduce the risk of flare ups that lead to extra visits to the GP, ambulance call outs or hospital attendance. Using an empty preventer inhaler will worsen asthma control.

A child attempting to treat their asthma attack with an empty reliever inhaler is also likely to fail.  12% of children attending hospital have empty inhalers. This is dangerous.

Objective 3. Reduce health inequality

As asthma disproportionately affects children and adults from less advantaged backgrounds, then improvements will help address health inequality.

How will the project be delivered?

Our team.

Includes doctors, nurses and pharmacists with a track record of working and publishing in this field. This includes leading national work on creation of a Greener Prescribing Guide for Children with Asthma and the NHSE Children and Young Persons’ National Asthma Bundle.

Our partners.

Alongside the sponsor, we are already working alongside the NIHR-Schools Network to deliver research in schools. We have successfully collaborated with partners (Smart Respiratory) to secure low-cost dose tracking devices and develop Android and Apple compatible software that is already in use.

Low risk, high value.

All our costs are low. This makes scalability possible.

Accurate scales that allows us to check the amount of medicine left in a puffer cost £12. A reusable dose-counter costs £25. Education can be delivered to a school for less than £500.

We will use data from weighing returned inhalers and the new NHSE CYP Asthma dashboard to measure our impact.

How is your project going to share learning?

Sharing learning.

Our project has the potential to make a big difference if we can share the learning and replicate our model. It would be rapidly scalable.

The 30 million salbutamol inhalers used each year in the UK contribute the equivalent of 3.4 Billion miles of car journeys to climate change.

This number alone captures the imagination and attention of the media. We have already published in the Lancet on this topic. (1)

Demonstrating the power of cross-system collaboration.

By working with schools and pharmacies we will provide a blueprint for other Q members who hope to take a similar approach.

Harnessing technology.

Simple answers are often the best. People have not been counting out their medicine because this is difficult. We hope that by making it easier, we will succeed.

Reference:

1. Carroll WD, Gilchrist FJ, Horne R. Saving our planet one puff at a time. Lancet Respir Med. 2022 May;10(5):e44-e45. doi: 10.1016/S2213-2600(22)00089-3. PMID: 35490695.