P3.N271: Reducing Climate Change Impact of Inhaler Therapies for Asthma and COPD

Purpose/Objectives: Inhalers are an integral part of treating asthma and chronic obstructive pulmonary disease (COPD). There are two main types of inhalers that deliver medications: metered dose inhalers (MDIs) and dry powder inhalers (DPIs). Both types of inhalers are FDA approved and are equally effective therapeutic options for most patients. The environmental impact due to greenhouse gas production is significantly different between inhaler types due to the mechanism of medication delivery. MDIs use a propellant called hydrofluoroalkanes (HFA) to deliver medication to the lungs. DPIs use the force generated by breathing to deliver the medication, without the need for these propellants. HFAs have the disadvantage of being a greenhouse gas, and their cumulative use can contribute negatively to climate change. One 120-dose MDI contributes as much to carbon emissions as a 115-mile car ride, or about 35kg CO2. DPIs, on the other hand, contribute less than 1kg CO2 per inhaler. The aim of this quality improvement project is to reduce the carbon footprint of our Internal Medicine-Pediatrics Clinic by reducing the number of prescribed MDIs in favor of DPIs.

Design/Methods: First, a comprehensive report was created detailing our clinic’s total inhaler prescriptions. This resident-led quality improvement project is ongoing and uses iterative PDSA cycles. Our first intervention was to educate colleagues regarding the environmental impact of different inhaler therapies. The second intervention was to create a set of clinical tools including patient resources, provider references, and EHR shortcuts/preference lists to guide prescribing practices. These were distributed to prescribing members of our clinic. Monthly reports were run to determine the total number of MDI and DPI prescriptions by provider. A total amount of CO2 saved is then calculated based on the difference between expected and actual prescribed inhalers.

Results: Baseline data from the 2022-2023 calendar year showed an average of 19.3 rescue albuterol and 20.3 controller MDI prescriptions per month compared to 0.4 rescue albuterol and 14.2 controller dry powder inhalers. Our project is currently in its second PDSA cycle. We have seen a variable increase in the number of dry powder inhalers prescribed monthly.

Conclusion/Discussion: We anticipate through iterative PDSA cycles to reduce greenhouse gas emissions from prescribed inhalers. We built an analytics tool to effectively track our prescribing practices. Challenges in changing prescriptions thus far have included insurance limitations on which inhalers are covered for patients. We also recognize that patients younger than 12 years of age cannot reliably utilize dry powder inhalers, and that there is no dry powder alternative for SMART therapy. We hope that using a shared decision-making model with patients when choosing an appropriate inhaler will satisfy our goals of sustainability, patient satisfaction, and upholding a high standard of clinical care.