Inhaler Carbon Footprint – MO opportunities


At the end of July 2023 NHSE published guidance titled “National medicines optimisation opportunities 2023/24”. This guidance describes the 16 national medicines optimisation opportunities for the NHS in 2023/24, and signposts to resources to help with their implementation. It recommends Integrated Care Boards (ICBs) choose at least five medicines optimisation opportunities to focus and deliver on alongside their local medicines optimisation priorities. Progress against chosen opportunities will be reviewed using available data.

This report focuses on improving respiratory outcomes while reducing the carbon emissions from inhalers and has data at SICBL, ICB and Commissioning Region level.

NHS England Aims: To improve patient outcomes and reduce carbon footprint of inhalers.

The report is provided to NHS colleagues only, please do not share outside the NHS.

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This publication is part of our Strategic Support and Planning contract. To gain access please email us at   

Additional resources

The RDTC has also produced an Inhaler Carbon Impact Assessment Tool



Data period

January 2021 to December 2023

Budget impact of acetylcysteine vs carbocisteine

The purpose of this bulletin is to highlight the difference in cost between acetylcysteine and carbocisteine when used as mucolytics, and to raise awareness of savings which could be achieved within ICBs. The bulletin considers the potential budget impact to primary care prescribing budgets based on current prescribing of carbocisteine across the ICSs in the North East & Yorkshire region and Greater Manchester.

This publication was updated in February 2024 after the removal of the Price concession from carbocisteine. All prices stated are from the February 2024 Drug Tariff

Inhaler Carbon Impact Assessment Tool


The NHS Long Term Plan outlines that 4% of the total NHS carbon footprint savings are expected to be realised through a ‘shift to lower carbon inhalers’ equivalent to a 50% reduction in the inhaler carbon footprint. 1,2 The RDTC has developed an inhaler carbon impact assessment tool in response to these targets. It is intended to be used at a commissioning level to estimate the impact of respiratory pathway choices made following a clinical decision making process.

This is not a clinical switch tool and should only be used as a calculator to estimate the impact of respiratory pathway choices already made following a clinical decision making process.

We have provided an open access version of the inhaler carbon impact assessment tool for download with national and regional level data. In order to access the full version of the tool which has stakeholder ICB and Sub-ICB level data either login to your account or you can request an account be set up by registering your details.


1. NHSE. NHS Long Term Plan.

2. Faculty of public health special interest group – sustainable development. The NHS: Carbon Footprint.

Data Period

October 2022 to September 2023



Respiratory System


This report looks at prescribing trends in primary care for the Respiratory System at SICBL and ICB level with particular focus on bronchodilators and corticosteroids. Prescribing data is weighted with QOF registers, and also uses HES data to measure prescribing to outcomes. The report also calculates the potential opportunity cost for respiratory drugs based on the NHS England Right Care indicators.

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Data Period

January 2021 to December 2023

Sustainability: Environmental impact of inhaler disposal

The NHS Long-Term Plan sets out a commitment to reduce NHS carbon emissions by 51% by 2025, and ultimately to become the world’s first Net-Zero health service. Good-quality data comparing the environmental impact of different types of inhalers is essential if patients and prescribers are to make informed decisions about their choice of inhalers in relation to their potential contribution to climate change.

The purpose of this bulletin is to review the current evidence on the relative contribution of the end-of-life disposal stage to the overall environmental impact of inhalers, and to highlight interventions which could reduce the environmental impact at end of use.

Considerations for Sustainable Inhaler Prescribing


Medicines in Practice is a series of evidence–based publications specifically designed to support stakeholder medicines optimisation services. The series aims to maximise health gains through the optimum use of medicines, by influencing and changing prescribing behaviour.

Inhalers account for approximately 3% of all NHS carbon emissions. Reducing the carbon impact from inhaler prescribing has been identified as a significant area of focus for delivering a net zero NHS. This document aims to outline strategies that can be considered to promote optimal respiratory care, while minimising the environmental impact from inhalers and consequences of suboptimal disease management

Reducing the carbon impact of inhalers across the North of England

This bulletin provides baseline figures on the current Inhaler Carbon Footprint at ICS level in the North of England, in order that systems can identify the level of response to be undertaken. It examines the current carbon footprint attributed to Inhalers in the North East and Yorkshire and the North West. It also analyses the Inhaler carbon footprint by therapeutic class, Inhaler type, and the contribution of hospital admissions for asthma towards total Inhaler carbon footprint.

Inhaler carbon footprint; significance, focus & action

Prescribing for Population Health (PPH) is an ongoing series that aims to support ICSs to improve the health of the populations they serve. PPHs use prescribing data, biomedical literature and other data sources to provide new insights.

The impact of climate change on health is increasing, as global warming continues to rise. 1 Within the health and social care sector, pressurised metered dose inhalers (pMDIs) and breath-actuated pMDIs (BA-pMDIs) have been identified as a significant contributing factor to the NHS carbon footprint.

This publication reviews current inhaler prescribing in the context of global warming potential data, and highlights interventions which should be considered by health systems.

There are three versions of this publication; please select the appropriate version for your region below.

The RDTC has also produced a carbon impact assessment tool for inhalers.

This publication is part of our Strategic Support and Planning contract. To gain access please email us at