Highlight
- Development of a web-based, tailored conversation aid to promote climate-conscious inhaler prescribing for asthma and COPD.
- Iterative user-centered design engaging 25 patients and 5 family physicians enhanced content clarity, usability, and messaging.
- The tool addresses dosing, safety, cost, and carbon footprint, mitigating patient concerns about inhaler switching and adherence.
- Both patients and physicians endorse increased confidence in selecting lower carbon footprint inhalers using the aid.
Study Background
Inhalers are essential for managing asthma and chronic obstructive pulmonary disease (COPD), but traditional metered-dose inhalers (MDIs) contain propellants with high greenhouse gas emissions contributing significantly to the carbon footprint of respiratory care. Growing recognition of climate change’s impact on public health has catalyzed efforts to promote climate-conscious inhaler prescribing—favoring dry powder inhalers (DPIs) and other low carbon footprint devices when clinically appropriate. However, device selection must balance environmental concerns with patient safety, affordability, and preferences to optimize adherence and disease control.
Despite recognized benefits, integrating environmental considerations into routine inhaler prescribing is complex. Clinicians and patients need accessible, evidence-informed tools to aid shared decision-making at the point-of-care, presenting carbon footprint data alongside safety and cost factors in understandable language. This study addresses this gap by developing and refining a digital conversation aid to support clinicians and patients in collaboratively selecting inhalers with lower environmental impact in asthma and COPD management.
Study Design and Methods
The researchers designed a web-based conversation aid prototype tailored by medication class (e.g., corticosteroids, bronchodilators), age group, and respiratory disease type (asthma, COPD, or overlap). The tool provided essential information for inhaler selection including inhaler ingredients, dosing regimens, carbon footprint estimates, cost, insurance coverage, and safety considerations.
An iterative rapid-cycle development process was utilized, comprising semi-structured interviews with family physicians, focus groups with patients, and an online survey to optimize content and usability. In each of five rounds, emerging themes and feedback were analyzed to guide revisions of wording, layout, and information prioritization. Distinct participants contributed across rounds until predefined stopping criteria were met, ensuring fresh perspectives and data saturation.
The patient cohort (n=25) comprised individuals with asthma (n=10), COPD (n=9), and asthma/COPD overlap (n=6), with a balanced gender distribution (44% women). Five family physicians participated. This collaborative approach embodied co-creation principles, prioritizing end-user perspectives in tool evolution.
Key Findings
Progressive revisions across five development rounds markedly improved the conversation aid’s accessibility and effectiveness. Key changes included:
- Language Simplification: Medical jargon was minimized, and plain language was used to enhance comprehension, particularly for patients with limited health literacy.
- Clarification of Cost and Coverage: Detailed explanations around drug costs and insurance reimbursement were emphasized to address a frequent barrier to device switching.
- Dosing Information: Clear, prominent dosing instructions helped mitigate confusion regarding inhaler use frequency and technique.
- Hover and Safety Messaging: Interactive elements such as hover-over explanations were highlighted to facilitate on-demand clarifications about safety and device differences.
- Addressing Patient Concerns: Messaging was sensitively revised to prevent inadvertent guilt or anxiety for patients unable or unwilling to switch to lower carbon footprint inhalers to maintain adherence and trust.
Feedback on tool effectiveness was highly positive among both patients and physicians. Participants rated content relevance, format, usability, and potential impact favorably, indicating the aid increased confidence in selecting environmentally preferable inhalers without compromising clinical safety or patient preferences.
Expert Commentary
The study exemplifies the importance of integrating environmental sustainability into clinical care through a patient-centered approach. By focusing on user engagement and iterative refinement, the developers created a pragmatic, scalable tool that could bridge the gap between high-level climate goals and day-to-day clinical decision-making.
Notably, the tool acknowledges multifaceted factors influencing inhaler choice beyond carbon footprint alone, including cost, safety, and patient preference—key determinants of real-world adherence and outcomes. This balanced approach aligns with current respiratory society guidelines emphasizing individualized, evidence-based prescribing.
Potential limitations include the relatively small sample size and the initial focus on family physicians, which may affect broader generalizability. Future studies assessing actual clinical implementation impact on inhaler prescribing patterns, patient adherence, and health outcomes are warranted.
Conclusion
This study successfully developed a clinically relevant conversation aid to support shared decision-making for climate-conscious inhaler prescribing in asthma and COPD. The user-centered, iterative design process ensured that the tool is user-friendly, rhetorically sensitive, and addresses the complex interplay of environmental, clinical, and personal factors influencing inhaler choice.
Implementation of such aids in routine practice offers a promising strategy to reduce respiratory care’s carbon footprint without compromising individualized patient care. Continued research into optimizing digital tools for environmental sustainability in healthcare will be essential as climate-conscious prescribing gains momentum globally.
Funding and Registration
The study was supported by institutional research funds as cited in the original article. No clinical trial registration was noted.
References
Butler SJ, Ning T, Balaci GA, et al. A Conversation Aid for Climate Conscious Inhaler Prescribing. Chest. 2026 Jun 15. PMID: 42297235.
Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2023.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2023.
Jeswani HK, Azapagic A. Life cycle environmental impacts of inhalers. J Clean Prod. 2019;237:117733.
