Collaboratively Sheffield place ICB, Sheffield teaching hospitals and Sheffield Children's hospital have developed new local COPD and asthma guidelines which not only put sustainability and green inhaler choices at the forefront but most importantly take on board all of the latest evidence and research to ensure our patients have access to the most evidence based respiratory medicines. At the heart of all of this is the message that GOOD RESPIRATORY CARE IS GREEN RESPIRATORY CARE. It became apparent that we had to move faster than the development of new national guidelines for the benefit of our patients and the environment. We worked together over a period of 6-12 months with consultant colleagues to assess the evidence and decide on the clear messages that we wanted to share across the city for both COPD and asthma patients.
Both guidelines include a variety of inhaler device type options and clear indication of which inhalers are the greener options – in the COPD guideline these are indicated by green footprints and due to the larger number of inhalers recommended within the asthma guidelines separate tables of greener lower carbon footprint and highlight carbon footprint inhalers have been included.
The focus of both guidelines is getting the maintenance treatment right and by doing so this should mean the patient uses less SABA inhaler for which the majority being prescribed across the UK are pMDI propellant containing inhalers. SABA reduction not only benefits the environment but the patient too. From an innovation point of view, we believe we are ahead of the curve in terms of adopting a COPD guideline which focuses on phenotypes and treatable traits. We believe our guideline highlights the need for early intervention with either dual bronchodilator or closed triple inhaler therapy and gives a clear decision-making pathway to support primary care clinicians have joint shared decision-making conversations with patients.
The asthma guidelines are innovative as we believe these are the first local guideline to be published which supports the licensed use of Budesonide/formoterol for as needed treatment of mild asthma with intermittent symptoms. Although other local guidelines may have previously eluded to this GINA approach for the use of ICS/formoterol until May 23 there was no licenced product in the UK. Our guideline includes a locally produced algorithm to support primary care clinicians with the safe initiation of this treatment approach including safety netting and support shared decision-making conversation and advice for patients.
