{"id":6564,"date":"2023-12-12T14:13:46","date_gmt":"2023-12-12T13:13:46","guid":{"rendered":"https:\/\/choosingwiselyitaly.org\/?post_type=raccomandazione-prof&#038;p=6564"},"modified":"2025-04-17T15:58:18","modified_gmt":"2025-04-17T13:58:18","slug":"do-not-routinely-prescribe-metered-dose-inhalers-but-dry-powder-inhaler","status":"publish","type":"raccomandazione-prof","link":"https:\/\/choosingwiselyitaly.org\/en\/raccomandazione-prof\/do-not-routinely-prescribe-metered-dose-inhalers-but-dry-powder-inhaler\/","title":{"rendered":"Do not routinely prescribe metered-dose inhalers but dry powder inhalers."},"content":{"rendered":"<p>Asthma and Chronic Obstructive Pulmonary Disease (COPD) have therapeutic benefits from inhalation medications, available in two pharmaceutical formulations: metered-dose inhalers and dry powder inhalers. Consequently, the prescription preference should be directed towards the latter for three distinct reasons:<br \/>\n\u2022 Ease of Administration: dry powder inhalers obviate the necessity for spacers or specific maneuvers, thus affording simplified utilization.<br \/>\n\u2022 Efficacy: powder formulations exhibit enhanced penetration into the distal airways compared to aerosol sprays, thereby optimizing therapeutic impact.<br \/>\n\u2022 Environmental Sustainability: aerosol inhalers employ hydrofluorocarbon propellants, potent greenhouse gases, thereby bearing a carbon footprint over 40 times higher than that of dry powder inhalers. This environmental burden is so substantial that it is estimated to account for 4% of the entire healthcare sector&#8217;s carbon emissions in the United Kingdom.<br \/>\nHowever, the choice must be shared with the patients and based on individual benefits and risks, also according to age and general conditions.<\/p>\n","protected":false},"featured_media":2380,"template":"","meta":{"_wpv_contains_gutenberg_views":[""],"_layouts_template":["modello-per-raccomandazioni-professionista"],"_wp_page_template":["default"],"_wpml_word_count":["{\"total\":303,\"to_translate\":{\"it\":303}}"],"_edit_lock":["1744898275:2"],"_edit_last":["2"],"_wpml_media_featured":["1"],"_wpml_media_duplicate":["1"],"_wpml_location_migration_done":["1"],"cmplz_hide_cookiebanner":[""],"_yoast_wpseo_primary_eta":["96"],"_yoast_wpseo_primary_disciplina":["127"],"_yoast_wpseo_primary_tipologia":["99"],"wpcf-pacchetto":["ISDE #2"],"wpcf-bibliografia":["1. Kerwin EM et al. ELLIPTA dry powder versus metered-dose inhalers in an optimized clinical trial setting. J Allergy Clin Immunol Pract. 2019;7:1843-49.\r\n2. Wilkinson A, et al. The environmental impact of inhalers for asthma: a green challenge and a golden opportunity. Br J Clin Pharmacol. 2022;88:3016-22.\r\n3. Fidler L et al Pressurized metered-dose inhalers and their impact on climate change. CMAJ 2022;194:E460. \r\n4. How to Reduce the Carbon Footprint of Inhaler Prescribing. A Guide for Healthcare Professionals in the UK https:\/\/www.greenerpractice.co.uk\/high-quality-and-low-carbon-asthma-care\/resources\/Environmental stewardship of pressurised metered-dose inhalers - https:\/\/codachange.org\/mdi-info\r\n5. Born KB, Levinson W, Vaux E Choosing Wisely and the climate crisis: a role for clinicians BMJ Quality & Safety Published Online First: 02 June 2023"],"wpcf-posizione-prof":["4"],"wpcf-collegare":["N"],"wpcf-link-intercheck-prof":["N"],"wpcf-parole-chiave-prof":[""],"wpcf-pdfpdf-prosfessionista":["https:\/\/choosingwiselyitaly.org\/wp-content\/uploads\/2023\/09\/Scheda-ISDE-MMG-green-english-3-corretta.pdf"],"wpcf-area-ordinamento":["General Practice and Primary Care"],"_yoast_wpseo_content_score":["60"],"_yoast_wpseo_focuskeywords":["[]"],"_yoast_wpseo_keywordsynonyms":["[\"\"]"],"_cmplz_scanned_post":["1"],"_wp_old_date":["2023-09-05"],"_thumbnail_id":["2380"],"_et_dynamic_cached_shortcodes":["a:4:{i:0;s:13:\"et_pb_section\";i:1;s:9:\"et_pb_row\";i:2;s:12:\"et_pb_column\";i:50;s:10:\"et_pb_text\";}"],"_et_dynamic_cached_attributes":["a:0:{}"],"et_enqueued_post_fonts":["a:3:{s:6:\"family\";a:1:{s:15:\"et-gf-work-sans\";s:136:\"Work+Sans:100,200,300,regular,500,600,700,800,900,100italic,200italic,300italic,italic,500italic,600italic,700italic,800italic,900italic\";}s:6:\"subset\";a:2:{i:0;s:5:\"latin\";i:1;s:9:\"latin-ext\";}s:9:\"cache_key\";s:75:\"{\"gph\":-1,\"divi\":\"4.27.6\",\"wp\":\"6.9.4\",\"enable_all_character_sets\":\"false\"}\";}"],"_et_builder_module_features_cache":["a:2:{i:0;s:84:\"{\"gph\":-1,\"divi\":\"4.27.6\",\"wp\":\"6.9.4\",\"tb\":{\"6368\":\"2023-03-16 11:14:40\"},\"wpe\":[]}\";i:1;a:4:{s:46:\"et_pb_section_91fa936ebb617131b2b56a2ba502d8b0\";a:5:{s:4:\"cuma\";b:1;s:4:\"mawi\";b:1;s:4:\"bosh\";b:1;s:5:\"mapac\";b:1;s:4:\"anim\";b:1;}s:42:\"et_pb_row_059cd63bb2a463cb90b14e6c9dcc0566\";a:3:{s:4:\"mawi\";b:1;s:4:\"bosh\";b:1;s:4:\"anim\";b:1;}s:45:\"et_pb_column_538b686ce80a620826cc9f316c3ac5c4\";a:3:{s:4:\"bosh\";b:1;s:3:\"pos\";b:1;s:4:\"anim\";b:1;}s:43:\"et_pb_text_0b5d770c54ecf96cc731c8b442804e81\";a:7:{s:4:\"glde\";a:10:{s:14:\"text_font_size\";s:2:\"14\";s:19:\"text_letter_spacing\";s:3:\"0px\";s:16:\"text_line_height\";s:5:\"1.7em\";s:16:\"header_font_size\";s:4:\"30px\";s:21:\"header_letter_spacing\";s:3:\"0px\";s:18:\"header_line_height\";s:3:\"1em\";s:15:\"background_size\";s:5:\"cover\";s:19:\"background_position\";s:6:\"center\";s:17:\"background_repeat\";s:9:\"no-repeat\";s:16:\"background_blend\";s:6:\"normal\";}s:4:\"foop\";b:1;s:4:\"tesh\";b:1;s:4:\"mawi\";b:1;s:4:\"bosh\";b:1;s:3:\"pos\";b:1;s:4:\"anim\";b:1;}}}"]},"eta":[{"term_id":96,"name":"Adult","slug":"adult","term_group":0,"term_taxonomy_id":96,"taxonomy":"eta","description":"","parent":0,"count":277,"filter":"raw"},{"term_id":97,"name":"Geriatric","slug":"geriatric","term_group":0,"term_taxonomy_id":97,"taxonomy":"eta","description":"","parent":0,"count":247,"filter":"raw"}],"disciplina":[127],"tipologia":"Drugs","class_list":["post-6564","raccomandazione-prof","type-raccomandazione-prof","status-publish","has-post-thumbnail","hentry","eta-adult","eta-geriatric","disciplina-general-practice-and-primary-care","tipologia-drugs"],"_links":{"self":[{"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/raccomandazione-prof\/6564","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/raccomandazione-prof"}],"about":[{"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/types\/raccomandazione-prof"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/media\/2380"}],"wp:attachment":[{"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/media?parent=6564"}],"wp:term":[{"taxonomy":"eta","embeddable":true,"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/eta?post=6564"},{"taxonomy":"disciplina","embeddable":true,"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/disciplina?post=6564"},{"taxonomy":"tipologia","embeddable":true,"href":"https:\/\/choosingwiselyitaly.org\/en\/wp-json\/wp\/v2\/tipologia?post=6564"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}