Multidisciplinary approach to addressing sustainable inhaler prescribing across primary and secondary care in North Central London (NCL).

<bold>Introduction</bold> Inhalers contribute 5% of carbon footprint in UK national health service. Better respiratory care is associated with greener prescribing and improved outcomes. A NCL group composed of pharmacists and physicians working together across primary and secondary care agreed upon aims and developed a work plan to address carbon footprint in line with national objectives. <bold>Aims</bold> To reduce carbon emissions from inhalers by 25% in 2023/24 versus 2019/20 by implementation of high-quality low carbon respiratory care across NCL in a collaborated effort. <bold>Methods:</bold> 1. Asthma and COPD guidelines developed to support prescribing of dry powder (DPI) rather than metered dose inhalers (MDI) as well as lower carbon Salbutamol inhalers. 2. Educational programmes delivered to the wider community teams to ensure broader uptake of the guidelines and support good disease management through prescribing of inhaled steroids and reduction in Salbutamol over-reliance with effective inhaler technique and adherence checks. 3. Data used to make informed decisions on achieving biggest impact with focus on incentives and trusts developing their own sustainable programmes. <bold>Results:</bold> 1. 28% of non-Salbutamol inhalers are DPI. 2. Reduction in CO2 inhaler emissions in NCL by 25% in 2023/24 compared to 2019/20 (Figure 1). 3. Secondary care is now working to replicating results above. <bold>Conclusions</bold> NCL has successfully superseded national targets of carbon reduction through joint working and implementation of local guidelines, educational strategies and greener initiatives.