Educational Intervention on Environmentally Responsible Inhaler Prescribing Among French General Practitioners: Pilot...

Climate change is expected to cause more than 250,000 deaths annually by 2050 and could increase the prevalence of asthma and chronic obstructive pulmonary disease (COPD) by up to 30%. Pressurized metered-dose inhalers (pMDIs), primarily delivering short-acting beta-2 agonists, generate 15 to 30 times more greenhouse gas emissions than dry powder or soft mist inhalers. In France, short-acting beta-2 agonist pMDIs account for 95% of reliever therapy prescriptions, despite their limited effectiveness in controlling disease symptoms.

This study aimed to evaluate the preliminary educational impact of a single educational session on French general practitioners' awareness and intended prescribing of lower-carbon inhaler alternatives.

We conducted a multicenter, single-group pre-post pilot study among 34 general practitioners from 10 multiprofessional health centers in Eastern Occitanie, France, between March and October 2023. Participants were recruited through convenience sampling. The intervention consisted of a one-time 25-minute face-to-face educational session on environmentally responsible inhaler prescribing, aligned with Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease guidelines. Data were collected using self-administered online questionnaires before the intervention and approximately 3 months later. The questionnaires included 2 clinical vignettes, one on asthma and one on COPD, with 3 prescribing questions each. Responses were categorized according to whether they included a pMDI. Changes in responses between baseline and follow-up were analyzed using the Fisher exact test or chi-square test, as appropriate.

A total of 34 participants completed the baseline questionnaire. Responses including a pMDI decreased from 70.6% (48/68) to 4% (3/68) for reliever therapy (P<.001) and from 21.3% (29/136) to 4.4% (6/136) for maintenance therapy (P=.003). In asthma scenarios, adherence to GINA recommendations improved, with increased responses including inhaled corticosteroid-formoterol for reliever therapy (6%, 2/34 to 38%, 13/34; P=.001) and maintenance therapy (35%, 24/68 to 56%, 38/68; P=.02). No significant improvements were observed for COPD-related prescribing scenarios. The proportion of participants reporting environmental impact as a factor influencing inhaler choice increased from 3% (1/34) to 51% (18/34). Satisfaction was high, with 93% of participants reporting being very satisfied with the intervention.

This pilot study suggests that a brief educational intervention may improve general practitioners' knowledge and intended prescribing of lower-carbon inhaler alternatives, particularly in asthma scenarios. However, the outcomes were based on theoretical clinical vignettes rather than real-world prescribing data, and the study was not designed to assess the safety or clinical effectiveness of changing inhaler prescriptions. Future studies should evaluate sustained changes in real-world prescribing while ensuring individualized, clinically appropriate, and safe inhaler choices.