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This pragmatic guide has been developed based on the work of the PCRS Greener Healthcare Working Group. In 2020, the PCRS Greener Healthcare Initiative brought together respiratory healthcare professionals working in primary and secondary care setting, public health specialist, patient advocacy organisations, patient representative, policy influences, service users and decision makers as well as representatives from the pharmaceutical industry.

In this article authors Daryl Freeman and Noel Baxter discuss some top tips you can implement locally to make the case for and influence others positively in support of greener respiratory healthcare.

In this article we discuss how to incorporate environmental considerations when selecting inhaler devices for patients newly diagnosed with respiratory disease. We also consider how to safely change to inhalers with a lower environmental burden when clinically appropriate and how to support patients in making the decision to change.  

As of April 2021, regional health and care needs in England will be coordinated through Integrated Care Systems (ICSs) (https://www.england.nhs.uk/integratedcare/what-is-integrated-care/).

An estimated 1.2 million people are living with COPD in the UK1 and research suggests that this number is growing (BLF 2020). Both external and internal environments can be implicated in the aetiology and control of respiratory conditions and people living with COPD are especially vulnerable to exacerbations brought on by poor air quality. PHE estimates that between 28,000 and 36,000 deaths in the UK are thought to be attributable to human-made air pollution (PHE 2019).

PCRS support initiatives to improve air quality and minimise short- and long-term damage to the environment, particularly those with an impact on climate change resulting from greenhouse gases.

The exhaled carbon monoxide (CO) test detects exposure to CO in the last 12-18 hours. This can be used to assess smoking status AFTER a quit attempt and used prior to a quit attempt as a motivational tool. Higher levels (parts per million) equate with greater inhalation of tobacco smoke assuming the cause is tobacco smoking. It must be noted that the exhaled CO test indicates recent exposure to CO and will not indicate smokeless tobacco use and is not a measure of dependency.