• The NHS aims to be the world's first net carbon zero health service and metered dose inhalers are a major contributing factor to the carbon footprint of the NHS. Where clinically appropriate, consider a dry powder inhaler for newly diagnosed patients. 
  • Following a thorough annual review of existing patients, consider switching from a MDI to a DPI with appropriate inhaler techniques counselling and inspiratory flow assessment. The majority of salbutamol inhalers are prescribed as MDIs, and a switch from Ventolin to Salamol or Airomir would lower the carbon footprint. This can also be achieved by reducing the number of salbutamol inhalers prescribed following thorough review. See Prescqipp for further information regarding the carbon footprint of inhalers. 
  • Generic prescribing of inhalers should be avoided as this might lead to patients being given an unfamiliar inhaler device, which they are not able to use properly. Different products and doses are licensed for different age groups and some may be applicable only to older children or adults (aged 18 years and over). Prior to prescribing, the relevant Summary of Product Characteristics (SPC) should be checked.
  • Some inhalers contain extra-fine particles (Qvar), making them more potent than others (Clenil). Take care to prescribe by brand.
  • On Formulary Preferred
  • On Formulary Second Line
  • On Formulary Third Line
  • Specialist Initiation
  • Secondary Care Only
  • Not Approved for Formulary