Environmental impact of inhalers - prescribing of non-salbutamol Metered Dose Inhalers (MDIs)

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description MDIs prescribed as a proportion of all inhalers in BNF Chapter 3, excluding salbutamol
Why it matters The NHS has committed to reducing its carbon footprint by 80% by 2028 to 2032, including a shift to lower carbon inhalers. Dry powder inhalers (DPIs) and other newer types of inhalers like soft mist inhalers are less harmful to the environment than traditional metered dose inhalers (MDIs).

The 2022-2023 PCN Investment and Impact Fund (IIF) includes an indicator focusing on the percentage of non-salbutamol MDI prescriptions issued. NHSE England’s aim is that, in line with best practice in other European countries, by 2023/24 only 25% of non-salbutamol inhalers prescribed will be MDIs.

NICE has produced a inhaler decision aid to facilitiate discussion about inhaler options.

Please note: as prescribing data does not contain patient information, this measure uses prescription items for all ages. This indicator is also calculated using items issued rather than prescriptions issued. The data shown will therefore not exactly match the IIF indicator.

Tags Standard, Greener NHS, NHS England Investment and Impact Fund, NICE, Respiratory
Implies cost savings No
Authored by brian.mackenna
Checked by richard.croker
Last reviewed 2022-05-22
Next review due 2023-05-22
Associated notebook https://github.com/ebmdatalab/jupyter-notebooks/blob/master/new_measures/Drafts/Enviromental%20Inhalers/Environmental%20Inhalers.ipynb
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(items) AS numerator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0301011ABBBAAA0", "0301011E0AAADAD", "0301011E0BDAAAD", "0301011U0AAACAC", "0301011U0AAAHAH", "0301011U0BBACAC", "0301011U0BBAFAH", "0301011U0BDAAAH", "0301011U0BEAAAH", "0301011U0BFAAAH", "0301011U0BGAAAH", "0301020I0AAAAAA", "0301020I0AAANAN", "0301020I0BBAAAA", "0301020I0BBAGAG", "0301020I0BBAJAN", "0301020I0BIAAAN", "0301020I0BJAAAN", "0301040AAAAAAAA", "0301040AABBAAAA", "0301040M0BBAAAA", "0301040R0AAAAAA", "0301040R0BBAAAA", "0302000C0AAAAAA", "0302000C0AAABAB", "0302000C0AAACAC", "0302000C0AAARAR", "0302000C0AAASAS", "0302000C0AAATAT", "0302000C0AABEBE", "0302000C0AABFBF", "0302000C0AABGBG", "0302000C0AABHBH", "0302000C0AABVBV", "0302000C0AABWBW", "0302000C0AABXBX", "0302000C0AABZBZ", "0302000C0BBAAAC", "0302000C0BCAHAB", "0302000C0BCAIAA", "0302000C0BCAQAR", "0302000C0BEACAT", "0302000C0BFAAAA", "0302000C0BFABAB", "0302000C0BFACAC", "0302000C0BFADAS", "0302000C0BFAFAU", "0302000C0BFAGAR", "0302000C0BJAABE", "0302000C0BJABBF", "0302000C0BJACBG", "0302000C0BJADBH", "0302000C0BJAEBG", "0302000C0BJAFBH", "0302000C0BPAABE", "0302000C0BPABBF", "0302000C0BPACBV", "0302000C0BPADBW", "0302000C0BQAABX", "0302000C0BQABBZ", "0302000C0BSAABE", "0302000C0BSABBF", "0302000C0BTAABE", "0302000C0BTABBV", "0302000C0BTACBF", "0302000C0BTADBW", "0302000C0BUAABX", "0302000C0BUABBZ", "0302000K0AAAAAA", "0302000K0AAADAD", "0302000K0AAAZAZ", "0302000K0AABABA", "0302000K0AABBBB", "0302000K0AABCBC", "0302000K0BBADAD", "0302000K0BBAEAA", "0302000K0BBAMAZ", "0302000K0BBANBA", "0302000K0BDADBB", "0302000K0BDAEBC", "0302000N0AABABA", "0302000N0AABCBC", "0302000N0AABEBE", "0302000N0AABFBF", "0302000N0AABGBG", "0302000N0AABHBH", "0302000N0AABJBJ", "0302000N0AABKBK", "0302000N0AABLBL", "0302000N0AABPBP", "0302000N0AABQBQ", "0302000N0BBAYBA", "0302000N0BBBABC", "0302000N0BBBBBH", "0302000N0BCADBE", "0302000N0BCAEBF", "0302000N0BCAFBG", "0302000N0BDAABJ", "0302000N0BDABBK", "0302000N0BDACBL", "0302000N0BDADBP", "0302000N0BDAEBQ", "0302000N0BFAABF", "0302000N0BFABBG", "0302000N0BGABBF", "0302000N0BGACBG", "0302000N0BIAABF", "0302000N0BIABBG", "0302000N0BJAABF", "0302000N0BJABBG", "0302000N0BLAABE", "0302000N0BLABBF", "0302000N0BLACBG", "0302000N0BPAABE", "0302000N0BPABBF", "0302000N0BPACBG", "0302000U0AAAAAA", "0302000U0AAABAB", "0302000U0BBAAAA", "0302000U0BBABAB", "0302000Y0AAAAAA", "0302000Y0BBAAAA", "0303010J0AAADAD", "0303010J0BBAFAD", "0303010Q0AAABAB", "0303010Q0AAANAN", "0303010Q0BBAFAB", "0303010Q0BBALAN")
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(items) AS denominator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0301011ABAAAAAA", "0301011ABBBAAA0", "0301011ABBBABAA", "0301011ABBBACAB", "0301011E0AAAAAA", "0301011E0AAABAB", "0301011E0AAACAC", "0301011E0AAADAD", "0301011E0BBAAAA", "0301011E0BCAAAB", "0301011E0BCABAC", "0301011E0BDAAAD", "0301011E0BEAAAC", "0301011U0AAAAAA", "0301011U0AAABAB", "0301011U0AAACAC", "0301011U0AAAEAE", "0301011U0AAAHAH", "0301011U0BBAAAA", "0301011U0BBACAC", "0301011U0BBAEAE", "0301011U0BBAFAH", "0301011U0BDAAAH", "0301011U0BEAAAH", "0301011U0BFAAAH", "0301011U0BGAAAH", "0301011V0AABBBB", "0301011V0BBARBB", "0301011X0AAAAAA", "0301011X0AAABAB", "0301011X0BBAAAA", "0301011X0BBABAB", "0301011Z0AAAAAA", "0301011Z0AAABAB", "0301011Z0BBAAAA", "0301011Z0BBABAB", "0301020I0AAAAAA", "0301020I0AAANAN", "0301020I0BBAAAA", "0301020I0BBAGAG", "0301020I0BBAJAN", "0301020I0BIAAAN", "0301020I0BJAAAN", "0301020Q0AAAAAA", "0301020Q0AAABAB", "0301020Q0AAACAC", "0301020Q0AAADAD", "0301020Q0AAAEAE", "0301020Q0BBAAAA", "0301020Q0BBABAB", "0301020Q0BBACAC", "0301020Q0BBADAE", "0301020Q0BCAAAD", "0301020Q0BDAAAA", "0301020Q0BEAAAA", "0301020Q0BEABAB", "0301020R0AAAAAA", "0301020R0BBAAAA", "0301020S0AAAAAA", "0301020S0BBAAAA", "0301020T0AAAAAA", "0301020T0BBAAAA", "0301040AAAAAAAA", "0301040AABBAAAA", "0301040M0BBAAAA", "0301040R0AAAAAA", "0301040R0BBAAAA", "0301040V0AAAAAA", "0301040V0BBAAAA", "0301040W0AAAAAA", "0301040W0BBAAAA", "0301040X0AAAAAA", "0301040X0AAABAB", "0301040X0BBAAAA", "0301040X0BBABAB", "0301040X0BCAAAA", "0301040Y0AAAAAA", "0301040Y0BBAAAA", "0302000C0AAAAAA", "0302000C0AAABAB", "0302000C0AAACAC", "0302000C0AAARAR", "0302000C0AAASAS", "0302000C0AAATAT", "0302000C0AABEBE", "0302000C0AABFBF", "0302000C0AABGBG", "0302000C0AABHBH", "0302000C0AABJBJ", "0302000C0AABSBS", "0302000C0AABUBU", "0302000C0AABVBV", "0302000C0AABWBW", "0302000C0AABXBX", "0302000C0AABYBY", "0302000C0AABZBZ", "0302000C0AACACA", "0302000C0BBAAAC", "0302000C0BCAHAB", "0302000C0BCAIAA", "0302000C0BCAQAR", "0302000C0BEACAT", "0302000C0BFAAAA", "0302000C0BFABAB", "0302000C0BFACAC", "0302000C0BFADAS", "0302000C0BFAFAU", "0302000C0BFAGAR", "0302000C0BHAAAG", "0302000C0BHADAK", "0302000C0BHAEAJ", "0302000C0BHAFAQ", "0302000C0BIAEBJ", "0302000C0BIAFBK", "0302000C0BJAABE", "0302000C0BJABBF", "0302000C0BJACBG", "0302000C0BJADBH", "0302000C0BJAEBG", "0302000C0BJAFBH", "0302000C0BLAABU", "0302000C0BLABBJ", "0302000C0BNAABU", "0302000C0BPAABE", "0302000C0BPABBF", "0302000C0BPACBV", "0302000C0BPADBW", "0302000C0BQAABX", "0302000C0BQABBZ", "0302000C0BRAABY", "0302000C0BRABCA", "0302000C0BSAABE", "0302000C0BSABBF", "0302000C0BTAABE", "0302000C0BTABBV", "0302000C0BTACBF", "0302000C0BTADBW", "0302000C0BUAABX", "0302000C0BUABBZ", "0302000K0AAAAAA", "0302000K0AAADAD", "0302000K0AAAGAG", "0302000K0AAAHAH", "0302000K0AAAKAK", "0302000K0AAALAL", "0302000K0AAAMAM", "0302000K0AAAUAU", "0302000K0AAAVAV", "0302000K0AAAWAW", "0302000K0AAAZAZ", "0302000K0AABABA", "0302000K0AABBBB", "0302000K0AABCBC", "0302000K0BBADAD", "0302000K0BBAEAA", "0302000K0BBAHAG", "0302000K0BBAIAH", "0302000K0BBAKAK", "0302000K0BBAMAZ", "0302000K0BBANBA", "0302000K0BDAAAL", "0302000K0BDABAM", "0302000K0BDACAU", "0302000K0BDADBB", "0302000K0BDAEBC", "0302000K0BFAAAV", "0302000K0BFABAW", "0302000K0BGAAAK", "0302000K0BGABAG", "0302000K0BGACAH", "0302000K0BHAAAM", "0302000K0BHABAU", "0302000K0BIAAAU", "0302000K0BIABAM", "0302000K0BIADAL", "0302000K0BJAAAM", "0302000K0BJABAU", "0302000N0AAAEAE", "0302000N0AAAFAF", "0302000N0AAARAR", "0302000N0AAASAS", "0302000N0AAATAT", "0302000N0AAAUAU", "0302000N0AAAXAX", "0302000N0AAAYAY", "0302000N0AAAZAZ", "0302000N0AABABA", "0302000N0AABCBC", "0302000N0AABEBE", "0302000N0AABFBF", "0302000N0AABGBG", "0302000N0AABHBH", "0302000N0AABJBJ", "0302000N0AABKBK", "0302000N0AABLBL", "0302000N0AABPBP", "0302000N0AABQBQ", "0302000N0AABRBR", "0302000N0BBARAR", "0302000N0BBASAS", "0302000N0BBATAT", "0302000N0BBAUAU", "0302000N0BBAYBA", "0302000N0BBBABC", "0302000N0BBBBBH", "0302000N0BCAAAX", "0302000N0BCABAY", "0302000N0BCACAZ", "0302000N0BCADBE", "0302000N0BCAEBF", "0302000N0BCAFBG", "0302000N0BDAABJ", "0302000N0BDABBK", "0302000N0BDACBL", "0302000N0BDADBP", "0302000N0BDAEBQ", "0302000N0BFAABF", "0302000N0BFABBG", "0302000N0BGAAAZ", "0302000N0BGABBF", "0302000N0BGACBG", "0302000N0BHAAAZ", "0302000N0BIAABF", "0302000N0BIABBG", "0302000N0BIACAY", "0302000N0BJAABF", "0302000N0BJABBG", "0302000N0BKAAAY", "0302000N0BKABAZ", "0302000N0BLAABE", "0302000N0BLABBF", "0302000N0BLACBG", "0302000N0BMAAAZ", "0302000N0BNAAAZ", "0302000N0BNABAY", "0302000N0BNACAX", "0302000N0BPAABE", "0302000N0BPABBF", "0302000N0BPACBG", "0302000N0BQABBS", "0302000R0AAAAAA", "0302000R0AAACAC", "0302000R0BBAAAA", "0302000R0BBACAC", "0302000U0AAAAAA", "0302000U0AAABAB", "0302000U0BBAAAA", "0302000U0BBABAB", "0302000V0AAAAAA", "0302000V0AAABAB", "0302000V0BBAAAA", "0302000V0BBABAB", "0302000V0BCAAA0", "0302000X0AAAAAA", "0302000X0AAABAB", "0302000X0AAACAC", "0302000X0BBAAAA", "0302000X0BBABAB", "0302000X0BBACAC", "0302000Y0AAAAAA", "0302000Y0BBAAAA", "0303010J0AAADAD", "0303010J0BBAFAD", "0303010Q0AAABAB", "0303010Q0AAANAN", "0303010Q0BBACAD", "0303010Q0BBAFAB", "0303010Q0BBALAN", "0307000R0AAAAAA", "0307000R0BBAAAA")
 GROUP BY month, practice_id