B38-09 Prescription Behavior Changes Among Pulmonary Fellows After Climate Change Education

Abstract Rationale Air pollution, longer pollen seasons, and extreme temperature shifts in climate change have been linked to increased incidence of asthma and chronic obstructive lung disease (COPD) exacerbations. Hydrofluorocarbon (HFC) propellant used in metered dose inhalers (MDIs) is a potent greenhouse gas contributing to climate change. Dry powder inhalers (DPIs) have been found to have over 10 times lower carbon footprint than MDIs and are non-inferior to MDIs in management of asthma in adults. This study evaluates prescription behavior practices of pulmonary fellows after a climate-based educational intervention. Methods This was a retrospective review approved by the Quality Improvement Committee of pulmonary and critical care medicine (PCCM) fellow outpatient encounters 3 months pre- and 3 months post-educational intervention. Outpatient encounters were selected based on chart-based diagnosis of asthma, COPD, or other obstructive diseases. Data collected included patient demographics, diagnosis, pulmonary function tests, insurance, and inhaler prescriptions. Descriptive statistics were used to analyze the data. Results A total of 96 pre-intervention and 143 post-intervention encounters were included. No appreciable difference was noted in prescriber behavior practice after intervention. Pre-intervention, 42% of all inhalers were HFCs and 37% were DPIs, and post-intervention, 42% were HFCs and 41% were DPIs. The most common initial choice of maintenance inhaler remained an HFC inhaler (36% pre-intervention and 47% post-intervention). Change in asthma control was cited as the most common reason for change in inhalers (71% of those documented). Seventy-five percent of patients were on Medicaid or Medicare or managed Medicaid or Medicare provider insurance coverage. That said, there were only three cases were when insurance coverage was cited as a reason for a change in inhaler management. Climate change was not cited as a reason for inhaler change pre- or post-intervention. Conclusion Despite effective educational intervention, prescription behavior changes in favor of more climate-conscious inhalers were not seen among pulmonary fellows. Notably, there are many uninvestigated variables that account for this lack of change, including not only risk versus benefit discussions in changing patient’s inhalers when their disease is well controlled as well as the lack of specific asthma guideline-concordant DPI formulations within the United States. Further research is needed to better understand the complex decision-making regarding inhaler choice in pulmonary clinics. These must be further investigated and are important to steer conversations on climate change advocacy within global pulmonary practice. This abstract is funded by: None