Swaffham Community Hospital

Introduction and ObjectiveInhaled asthma therapy contributes to global warming but is currently a non-negotiable element of patient care. The carbon footprint of inhalers has previously been described. Pressurised metered dose inhalers (pMDIs) may have a higher carbon footprint than dry powder inhalers (and soft mist inhalers), but the volume of inhalers is also an important contributor. Those with poor asthma control may have higher numbers of inhalers prescribed. We sought to determine whether people with self-reported poor asthma control (Royal College of Physicians 3 Questions for Asthma (RCP 3 questions)) contributed a different carbon footprint to those with better control.MethodsNational Services for Health Improvement (NSHI) staff conduct primary care clinical assessments of people with asthma. Permission has been obtained from participating practices for NSHI to hold anonymised aggregated routinely collected data. Between 1stJanuary 2022 and 30th April 2023, NSHI conducted respiratory audits in 447 practices across 111 CCGs/Health Boards/ICBs in the UK. Demographic data, RCP 3 questions, inhaler brands and number of items prescribed for each patient were collected throughout this period. Greenhouse gas (GHG) emission values per inhaler were allocated from a publicly available source (PrescQIPP).1 Numbers of prescribed inhalers were multiplied by the GHG emission values per inhaler to give total GHG emissions per year.ResultsComplete data were available for 116,841 individuals aged between 20–69 years: 59.2% female. The median (lower quartile, upper quartile) GHG was 77.0 (28.7, 160.1) Kg CO2/year. The minimum value was 0 CO2 Kg/year and the maximum value 1336.2 Kg CO2/year.The number of patients and total GHG emissions from inhaler use by RCP 3 questions score (0–3) are shown. P47 Table 1Number of patients and total GHG emissions by RCP scoreRCP score % (n) patients Total GHG inhaler emissions per year (Kg CO2/year) Median (lower quartile, upper quartile) P-value 0123 26.2 (30,594)43.3 (50,559)20.3 (23,736)10.2 (11,952) 60.4 (24.2, 130.9)73.1 (28.6, 152.2)89.8 (33.2, 183.7)116.5 (43.7, 234.6) <0.001 ConclusionIn asthma patients with a self-reported, single assessment of asthma control, those with a higher RCP 3 questions score (poorer control) contributed a higher inhaler related GHG emission.ReferenceBulletin 295: Inhaler carbon footprint | PrescQIPP C.I.C.Please refer to page A289 for declarations of interest related to this abstract.

<b>Introduction:</b> The Global Initiative for Chronic Obstructive Lung Disease (GOLD) have published their 2017 report. In 2014 we published the classification according to GOLD 2013 of a large database of people with COPD.¹ <b>Aim:</b> We now describe the same population using the GOLD classification 2017 <b>Methods:</b> We re-analysed the database drawn from 80 UK practices representative of UK primary care. An electronic search of practice databases and a hand search of individual patient records was conducted. Demographic data and co-morbid conditions were documented. <b>Results:</b> 9219 patients had their exacerbation history recorded. 7480 had spirometry results. 7119 patients had an MRC score. Table 1 The original distribution of this cohort of patients, according to the GOLD 2013 categories Table 2 The distribution of patients according to the GOLD 2017 revised COPD assessment. ^#: ≥1 hospitalisations Conclusion The proportion of people with COPD under treatment in the high-risk groups C and D falls from 48.0% (2013) to 29.6% (2017). The GOLD 2017 ABCD tool results in greater homogeneity as the risk stratification is based on exacerbation history alone. This revision of the COPD grading system is commendably clear, avoiding the need for sub-classification of patients. It will therefore be useful for practising clinicians in patient management. 1. Haughney et al Eur Respir J 2014; 43: 993-1002.