Green with Asthma

How can I be more green? Cycle to work? No more steak? Stop my inhaler…?

HOW CAN I BE MORE GREEN? CYCLE TO WORK? NO MORE STEAK? STOP MY INHALER...?

Many of us of are becoming more carbon-conscious. Whether this means cutting down on red meat (turns out the vegans were right all along), using the car less (until we can actually afford a Tesla), or skiing in Australia instead of getting on a plane (which may actually be preferable to managing small children in an enclosed space at 10,000ft), there is more that most of us can do.

But if you have asthma, how should you react to the recommendation in the latest BTS / SIGN guideline on asthma management to use inhalers with a low-global warming potential? BTS and SIGN are not alone here. In April NICE also made similar recommendations. While changes are happening overseas, it seems to have not made much of a splash in Australia, leaving many somewhat confused.

Context is useful.

You might remember hearing about "CFCs" — chlorofluorocarbons — and their dire effect on the ozone layer. These were phased out of various uses, including in the metered dose inhaler, in accordance with the international treaty, the Montreal Protocol, starting in August 1989.

But CFCs were replaced with "HFCs" — hydrofluorocarbons. Safe for the ozone layer, but potent global warming gases. 

A recent amendment to the Montreal Protocol has now planned a phase-out of HFCs too. But it's slow, with deadlines decades away. Earlier prudent management of these gases could make a big difference to climate change.

A person using a preventer inhaler monthly, plus the odd reliever inhaler, could easily release the annual equivalent of a quarter of a ton of carbon dioxide. That's like burning 100 litres of petrol.

There are simple alternatives

Dry powder inhalers have 25x less carbon footprint than MDIs or breath-actuated inhalers.

It's feasible for many people, but not all, to use either sort of device. Young children do better with metered dose inhalers and spacers, as do people who struggle to inhale. But most asthmatics can inhale well from dry powder inhalers.

The two types of inhaler seem to work just as well as each other. If anything the dry powder ones might be a little better.

Metered dose inhalers are more often prescribed than dry powder devices in many countries. But this has more to do with history and familiarity than effectiveness.

However, patients can be flexible. Most would be happy to try something different and, given the relevant information, many would be doubly keen to. So now is the time for us to educate ourselves a bit more on the plethora of options at our fingertips. The good news is that, while there is a confusing array of inhalers on the market, there are also excellent resources to help. 

Resources

The Asthma and COPD Medications chart was developed independently by the National Asthma Council Australia and has the details of most commonly available asthma and COPD inhalers in Australia. The Australian Asthma Handbook is also a fantastic resource.

For further information, Asthma Australia is a veritable font of knowledge with lots of instructional resources for ensuring good inhaler technique.

Australia switched smoothly from CFC to HFA inhalers in order to protect our environment. Is it time for another change?

This article was originally published on the NB Medical Education Hot Topics Blog on 15 August 2019. Edited by El Carey 29 August 2019.

{{commentCount}} comment(s). You must be logged in and AHPRA verified to view and comment. Login here.

Dr Neal Tucker

Neal is the E-learning lead for NB Medical Education and a lecturer on the Hot Topics course. Having previously been a partner in an Oxford practice, he now works on a sessional basis around Oxford to facilitate his educational work.

The latest healthcare news from medcast

Telehealth: How does it work In Practice
Telehealth: How does it work In Practice

We are all starting to do telehealth in the current climate to protect us, our staff and our patients. Many of us feel slightly out of our depth. Here are some quick tips to help you in your practice.

Telehealth and COVID-19 Update
Telehealth and COVID-19 Update

As the number of cases of COVID-19 increases exponentially in Australia many of us will be exploring the new telehealth item numbers. The information on these seem to be changing daily, but currently these are the key things to know.

Coronavirus
Coronavirus

Since the start of 2020, coronavirus has hit the world and caused unprecedented levels of concern among public and health professionals alike.

Oropharyngeal Airways in Paediatric Patients
Oropharyngeal Airways in Paediatric Patients

Oropharyngeal airways (OPAs) have some additional considerations when utilising in paediatric patients, to ensure safe use in children.

Why are we so bad at making the self-care message stick?
Why are we so bad at making the self-care message stick?

“I looked at that list you gave me.” There was no mistaking the anger in my patient’s eyes. “I can’t believe you would suggest that I could get better from this by taking some deep breaths or going for a walk! I don’t think you understand my situa...

PODCAST: Iliotibial Band Syndrome
PODCAST: Iliotibial Band Syndrome

Milo, aged 26, comes to see you with lateral knee pain. As GPs how do we diagnose, treat and manage this?

Easing the Lingering Symptoms of Depression
Easing the Lingering Symptoms of Depression

Despite our best efforts, most patients who experience depression are left with residual symptoms that linger beyond the completion of treatment. Whether it be low motivation, low mood, self-criticism, guilt or worry, residual symptoms of depressi...

Recognising and responding to deteriorating patients: a matter of life or death
Recognising and responding to deteriorating patients: a matter of life or death

The most recent update of the Australian Institute of Health and Welfare’s (AIHW) Deaths in Australia report shows that in 2017 there were a total of 160,909 recorded deaths in Australia. 50% of these were found to be potentially avoidable within ...

A new approach to mental health care
A new approach to mental health care

I’m a GP with a special interest in mental health. For the past three years I have been working with Medibank health solutions to support the implementation of a range of programs for people with chronic and complex health conditions.

Out of Office - Dr Simon Curtis
Out of Office - Dr Simon Curtis

Find out more about Simon, co-founder of the Hot Topics course internationally in his 'Out of Office' before seeing him in person at Hot Topics Australia.

Team GP – why we need to learn together
Team GP – why we need to learn together

Learning is all about making some sort of change. As GPs, it can be easy for us to think of our learning simply as a process we go through to tick a box. But maybe we should be thinking more deeply about the types of learning that truly cause us t...

PODCAST: Hypocalcaemia
PODCAST: Hypocalcaemia

Sundeep, a 63 year old office worker, presents with intermittent nagging loin pain and achy muscles.

Stop Before You Block: A Block Time-Out
Stop Before You Block: A Block Time-Out

The Stop Before You Block (SB4YB) initiative is a patient safety campaign designed to help reduce the risk of inadvertent wrong-sided anaesthetic blocks.

Moments of Joy
Moments of Joy

This year I’ve decided to practice what I preach. I’m starting with something that has evolved from last year’s eye-opening experience with keeping a gratitude diary when, along with other members of my team at work, I participated in the 6-week M...

Vaping - Friend or Foe?
Vaping - Friend or Foe?

Where are we with vaping? Are e-cigarettes the shining knight who will rid the world of cigarettes or dangerous products wrapped up in clever marketing with the 'unintended consequence' of luring young people into the world of smoking?

On being a GP seeking help
On being a GP seeking help

I had an interesting experience at my GP recently. I don’t go to the GP very often. Mostly I don’t get sick. Sometimes I treat my own ills or just soldier on. On the few occasions that I have been to see someone about something concerning me, my ...

Let’s talk about self-soothing
Let’s talk about self-soothing

I talk to a lot of health professionals and it amazes me how often people look at me blankly when I introduce the subject of self-soothing activities. As the conversation progresses I can see most of the blank looks turn to some degree of understa...

Can I have medical cannabis on PBS doctor?
Can I have medical cannabis on PBS doctor?

I’ve been asked this question twice in the last month. Once by a 70 year old patient who has taken up smoking weed to control her neuropathic pain, let’s call her ‘Rachel’. And the other a young man aged 26 (Sean) who is smoking cannabis to help c...

Standardising Emergency Numbers: The Push for 2222
Standardising Emergency Numbers: The Push for 2222

The move to standardise emergency numbers within hospitals, to make them similar to the standardised emergency numbers that are utilised in the community setting, is gaining momentum.

PODCAST: Acute Diverticulitis
PODCAST: Acute Diverticulitis

Stan, aged 80, comes to see you with left side abdominal pain and a low-grade fever. This is a classic example of a common problem doctors face in General Practice. In our Podcast we discuss Diagnosis, Assessment, Management & Referral.

Join Medcast. It's free and you'll get instant access to essential healthcare news, research and more.

Already a member? Sign-in