Sustainable Inhaler Prescribing

inhalers questionnaire graphics

Green Agenda: Sustainable Inhaler Prescribing

Survey to establish the consensus on the proposal to cease the prescribing of Ventolin Evohaler and Salbutamol MDI

Please read the following context information and then proceed to the short survey at the bottom of the email.

You are welcome to share this email with healthcare professional colleagues within Wales.

Hydrofluorocarbon / hydrofluoralkane propellants from metered dose inhalers contribute 3.5% of the total carbon footprint of the NHS. This amounts to 65,000 tonnes of CO2 equivalent each year in Wales alone.

We have national guidelines, patient apps and educational modules which address the Green Agenda and support switches to dry powder inhalers.

Wales has an ambitious target to reduce the proportion of MDI from 70% to less than 20% by 2025, which, if achieved will reduce the amount of CO2 equivalent released into the atmosphere by 45,000 tonnes each year.

Current data demonstrate that Ventolin Evohaler or generic Salbutamol inhaler pMDIs are by far the most commonly prescribed inhalers, with more than 100,000 devices prescribed and dispensed in primary care in Wales every month. In combination, they contribute about 66% of the total inhaler carbon footprint each year. Moreover, data from the WAPSU inhaler dashboard show that the proportion of MDI’s prescribed is increasing in each Health Board in Wales.

We highlight the following facts:

  • Ventolin Evohaler and generic Salbutamol pMDIs contributes 66% of the total carbon footprint from all inhalers in Wales (1)
  • It is a member of the least effective class of inhalers for patients with both asthma and COPD
  • It is rarely used with a spacer, and thus is even less likely to have any therapeutic effect (2)
    83% of prescriptions of these inhalers for asthmatics went to patients overusing them (3)
  • Equally effective alternatives exist which can reduce the carbon footprint by 50% (Salamol pMDI) or 98% (any SABA DPI)

We, therefore, wish to gain consensus amongst the medical community in Wales as to whether they support the proposal that salbutamol in the form of Ventolin Evohaler/salbutamol pMDI should no longer be prescribed.


Gaining consensus is the first step in the process whereby we hope to influence procurement. We expect this process to be time consuming and difficult, but we believe that in the context of the climate emergency, the NHS should be leading the way in reducing its carbon footprint.

In order to establish consensus, please provide your anonymous response within the short survey below to indicate your views on the proposal

You will be asked for some brief anonymous details about your Health Board, profession and specialism and will also be able to provide further comments.