In primary care, one of the largest sources of greenhouse gases are from pressurized metered-dose inhalers (pMDIs). pMDIs are an effective delivery device for respiratory illnesses, however they contain HFA, a powerful greenhouse to propel medication into a patient’s lungs Furthermore, about a third of patients prescribed inhalers do not have an objective diagnosis of asthma or COPD. Choosing Wisely Canada recommends only continuing treatment with objective confirmation of asthma or COPD. Additionally, the Canadian Thoracic Society updated national guidelines for the management of very mild and mild asthma; this includes initiation of a combination dry powder inhaler (formoterol/budesonide) instead of HFA-containing short-acting beta agonist therapy. Given the under-testing for asthma diagnosis and historical prescription of HFA-containing puffers as first-line therapy, we suspect a large burden of inappropriate, suboptimal asthma care in Canada. Our goal is to reduce pMDI prescriptions at the Queen’s Family Health Team (QFHT) by 50% by June 2023.

We re-designed the Quality Improvement and Patient Safety (QIPS) curriculum for our first year post graduate family medicine residents to tackle inappropriate inhaler prescriptions and switching appropriate prescriptions to more environmentally friendly options. Residents received training focused on healthcare sector’s impact on the environment and QIPS. These future family physicians then worked in clinical teams and competed to see which team had the largest overall decrease in pMDIs. Each resident team had autonomy to decide how they approach the problem (e.g., switch inhaler device, check for diagnostic lung function testing and deprescribe where possible). Each month, metrics on pMDI prescriptions were shared with the entire health team.

At the start of this project, we found that 58% of all inhaler prescriptions within our health team were pMDIs, and eight months into the project, we observe asignficant reduction in pMDI prescriptions, and a corresponding increase in DPI prescriptions. Total carbon deprescribing will be calculated. The project completes in June 2023.