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Abstract：
Pressurised metered-dose inhalers (MDIs) have a much higher carbon footprint than dry powder inhalers (DPIs). We aimed to describe variations of inhaler options in local adult asthma prescribing guidance.
We reviewed local clinical commissioning group (CCG) adult asthma prescribing guidance for primary care in England in 2019 and recorded DPI and MDI inclusion. The relationship to prescribing data from OpenPrescribing.net was examined.
In total, 58 unique guidance documents were analysed covering 144 out of 191 CCGs in England. Only 3% of CCG guidelines expressed an overall preference for DPIs, while 12% explicitly preferred MDIs. The inclusion of DPIs first-line was 77% for short-acting β-agonists, 78% for low-dose inhaled corticosteroid (ICS) inhalers and 90-96% for combination long-acting β-agonist/ICS inhalers. MDIs were included first-line in 98-100% of these classes. In 26% of CCGs, there was no first-line DPI option for at least 1 asthma management step. Ten percent of CCGs had no DPI included first-line for any of the 5 classes examined. Many CCGs recommended higher carbon footprint options; Ventolin MDI (25.6%), inhalers containing HFA227ea (57.9%) and ICS regimes recommending 2 puffs of a lower dose over 1 puff of higher dose (94.2%). MDIs were prescribed more in CCGs that recommended them.
Before the COVID pandemic, there was substantial variation between CCGs in adult asthma prescribing guidance regarding higher and lower carbon footprint options. There may still be scope to amend local guidance to improve clinical and environmental outcomes. This study provides a method and baseline for further investigation of this.
We reviewed local clinical commissioning group (CCG) adult asthma prescribing guidance for primary care in England in 2019 and recorded DPI and MDI inclusion. The relationship to prescribing data from OpenPrescribing.net was examined.
In total, 58 unique guidance documents were analysed covering 144 out of 191 CCGs in England. Only 3% of CCG guidelines expressed an overall preference for DPIs, while 12% explicitly preferred MDIs. The inclusion of DPIs first-line was 77% for short-acting β-agonists, 78% for low-dose inhaled corticosteroid (ICS) inhalers and 90-96% for combination long-acting β-agonist/ICS inhalers. MDIs were included first-line in 98-100% of these classes. In 26% of CCGs, there was no first-line DPI option for at least 1 asthma management step. Ten percent of CCGs had no DPI included first-line for any of the 5 classes examined. Many CCGs recommended higher carbon footprint options; Ventolin MDI (25.6%), inhalers containing HFA227ea (57.9%) and ICS regimes recommending 2 puffs of a lower dose over 1 puff of higher dose (94.2%). MDIs were prescribed more in CCGs that recommended them.
Before the COVID pandemic, there was substantial variation between CCGs in adult asthma prescribing guidance regarding higher and lower carbon footprint options. There may still be scope to amend local guidance to improve clinical and environmental outcomes. This study provides a method and baseline for further investigation of this.
摘要：
加压计量吸入器（MDI）的碳足迹比干粉吸入器（DPI）高得多。我们旨在描述当地成人哮喘处方指南中吸入器选择的变化。
我们回顾了2019年英格兰初级保健的当地临床调试组（CCG）成人哮喘处方指南，并记录了DPI和MDI的纳入情况。检查了与来自OpenPrescribing.net的处方数据的关系。
总共，对58份独特的指导文件进行了分析，涵盖了英格兰191份CCG中的144份。只有3%的CCG指南表达了对DPI的总体偏好，而12%的人明确首选MDI。短效β-激动剂一线纳入DPI的比例为77%，低剂量吸入性皮质类固醇（ICS）吸入器占78％，长效β-激动剂/ICS联合吸入器占90-96％。MDIs被包括在这些类别的98-100%中的一线。在26%的CCG中，对于至少1个哮喘管理步骤,没有一线DPI选项.在所检查的5个类别中，有10％的CCG没有包括DPI。许多CCG推荐了更高的碳足迹选择；VentolinMDI(25.6%)，含有HFA227ea（57.9％）的吸入器和ICS方案建议2次较低剂量的抽吸，而1次较高剂量的抽吸（94.2％）。建议使用的CCG中规定了更多的MDI。
在COVID大流行之前，在成人哮喘处方指导中,CCGs在碳足迹较高和较低的选择方面存在显著差异.可能仍有修改当地指南以改善临床和环境结果的余地。本研究为进一步调查提供了方法和基线。
我们回顾了2019年英格兰初级保健的当地临床调试组（CCG）成人哮喘处方指南，并记录了DPI和MDI的纳入情况。检查了与来自OpenPrescribing.net的处方数据的关系。
总共，对58份独特的指导文件进行了分析，涵盖了英格兰191份CCG中的144份。只有3%的CCG指南表达了对DPI的总体偏好，而12%的人明确首选MDI。短效β-激动剂一线纳入DPI的比例为77%，低剂量吸入性皮质类固醇（ICS）吸入器占78％，长效β-激动剂/ICS联合吸入器占90-96％。MDIs被包括在这些类别的98-100%中的一线。在26%的CCG中，对于至少1个哮喘管理步骤,没有一线DPI选项.在所检查的5个类别中，有10％的CCG没有包括DPI。许多CCG推荐了更高的碳足迹选择；VentolinMDI(25.6%)，含有HFA227ea（57.9％）的吸入器和ICS方案建议2次较低剂量的抽吸，而1次较高剂量的抽吸（94.2％）。建议使用的CCG中规定了更多的MDI。
在COVID大流行之前，在成人哮喘处方指导中,CCGs在碳足迹较高和较低的选择方面存在显著差异.可能仍有修改当地指南以改善临床和环境结果的余地。本研究为进一步调查提供了方法和基线。
