Too Much Blue: Reducing inhaler carbon footprint through tackling SABA overuse in asthma patients

Humber and North Yorkshire ICB

Project summary

In Humber and North Yorkshire ICB, we have successfully reduced the carbon footprint of inhalers through a focus on patient safety. By focusing on tackling "Too much Blue" in asthma patients our interventions gained widespread clinical leadership support and resulted in a steeper reduction in inhaler carbon footprint and SABA overuse than neighbouring ICBs.

In the UK, approximately 2/3rds of the inhaler carbon footprint comes from the overuse of reliever metered dose inhalers, which are used for temporary relief when asthma patients have symptoms and are called Short-acting Beta-agonist (SABA) inhalers. Overuse of SABA inhalers, which is defined at 3 or more SABA inhalers a year, is associated with poorer patient outcomes in terms of symptom control, asthma attacks and deaths.

PrescQipp data shows that HNY ICB achieved a 12.1% reduction in the inhaler carbon footprint (2,911,190,108 gCO2e) if we compare the 12 months to Dec 2024 (24,041,771,953gCO2e) to the 12 months to Dec 2025 (21,130,581,845gCO2e).

The reduction in our inhaler carbon footprint has been consistent with our focus on reducing the 2/3rds of the inhaler carbon footprint associated with poor asthma control and reliever (SABA) overuse. Of the 39.6% reduction overall for 2019/2020 baseline figures, 36.9% reduction is from relievers and 2.7% reduction from other inhalers.

Epact 2 data show that in the same time period we have achieved a 4.86% percentage reduction in asthma patients who are significantly overusing SABA (6 or more SABA inhalers) from 16.71% in December 2024 to 11.85% in December 2025. This is a lower figure than the national average despite our significant deprivation known to affects poor asthma control and SABA overuse. It is also a steeper decline of 29% in HNY ICB vs 22% nationally.

This success can be attributed to several factors. Work on reducing inhaler carbon footprint has been a key area of focus for the Clinical Lead for Sustainability who has coordinated efforts with the medicines management team, the Respiratory Clinical Network and the Children and Young Person's team. SABA overuse reduction was a joint priority for all these teams. Representatives from all these teams attended the All-age Asthma steering group and Respiratory clinical network meetings. The following actions were integrated and re-inforced the SABA overuse message.

1) All-age asthma guidance for clinicians with clear support for reducing SABA overuse

2) The "Too Much Blue" campaign aimed at healthcare professionals to raise awareness of the risks to asthma patients from SABA overuse

3) Widespread and repeated healthcare professional education at webinars and in-person protected learning events educating on new asthma guidance alongside the message on SABA overuse