Environmentally friendly inhaler decision-making with personalized care in asthma and chronic obstructive pulmonary disease: a qualitative study

Exploratory Research in Clinical and Social Pharmacy, vol. 20, pp. 100651

Abstract

Background: Green behavioral shifts in prescribing habits, device selection and patient counseling have been proposed to deliver low-carbon sustainable healthcare, including the transition from pressurized metered-dose inhalers (pMDIs) to propellant-free inhalers. Objective: This study explores the extent to which healthcare professionals (HCPs) and patients can factor the environmental impact into inhaler decision-making with personalized care in asthma and chronic obstructive pulmonary disease (COPD). Methods: An exploratory qualitative study was conducted involving seven focus groups and one semi-structured interview with 22 participants consisting of general practitioners, community pharmacists, pulmonologists, assistants and patients. Data was analyzed deductively to identify challenges and facilitators related to capability, opportunity and motivation; and inductively for actions to foster environmentally conscious behavior. Results: Overall, participants felt a moral responsibility and were willing to opt for environmentally friendly inhaler initiatives including a shift from pMDIs to dry-powder inhalers (DPIs), if clinically appropriate and performed as outcome of shared decision-making. Collaboration between researchers and relevant stakeholders was required to strengthen their capacity to advance in this area. Proposed strategies covered five areas: (1) communication, education and awareness; (2) appropriate inhaler prescribing; (3) promotion of smarter inhaler choices; (4) optimization of quality of care; and (5) appropriate inhaler disposal. Conclusion: These findings guide the delivery of a range of opportunities to improve quality of care while simultaneously reduce carbon footprint. This requires a multifactorial and interdisciplinary approach with HCPs playing a central role in engaging and educating patients to determine the viability of environmentally friendly alternatives, promote correct inhaler use and appropriate disposal.

Authors 3

1. Claire D. Visser Aachen Department of Clinical Pharmacy and Toxicology

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands

2. Henk‐Jan Guchelaar Aachen Department of Clinical Pharmacy and Toxicology

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands

3. Martina Teichert corresponding Aachen Department of Public Health and Primary Care

   Leiden University Medical Center · Royal Dutch Pharmacists Association

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands

   Department of Research and Development, Royal Dutch Pharmacists Association, The Hague, the Netherlands