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Home » Supporting the NHS » A greener NHS: working in partnership towards a carbon-free future in asthma care

Tom Keith-Roach

President, AstraZeneca UK

Every year, the world feels the effects of the climate crisis, and our current trajectory towards 1.5°C global warming demands urgent action.1 A partnership is setting an example of improving respiratory care and health outcomes while reducing CO2 emissions.

Many industries significantly impact the environment, and healthcare is no different. The NHS contributes 4% of overall emissions in the UK.2 Medicines constitute part of this footprint.

Working towards a healthier planet with healthier people

Short-acting beta-agonist (SABA) ‘blue inhalers’ make up 2% of all NHS emissions.3 These SABA inhalers are widely overused4 and for far too long have been the backbone of asthma care.

Leading clinical societies — for example, both the Global Initiative for Asthma (GINA) and the UK Primary Care Respiratory Society — have issued guidance in which SABA-only treatment is to be avoided for safety reasons, and SABA is no longer the preferred reliever treatment.5,6

The impact on wellbeing and the environment from using SABAs has been staggering. People with asthma who consume three or more blue inhalers per year account for 83% of SABA usage, resulting in over 250,000 tonnes of CO2 emissions annually.7

At AstraZeneca UK, our mission is to provide exceptional patient care to help play our part in striving towards a healthy planet with healthy people. We are taking bold action on the climate crisis and pursuing ambitious decarbonisation targets through purpose-led partnerships and the implementation of sustainable healthcare solutions. We are committed to achieving net zero carbon by 2045. We’re partnering with the NHS to support this, and SENTINEL is one powerful example.

Transforming asthma care

SENTINEL is an AstraZeneca-sponsored partnership with Hull University Teaching Hospitals NHS Trust and Hull York Medical School. It identifies and risk-stratifies those with asthma who are over-reliant on SABAs and, where appropriate, supports their transition to other care plans, per recent guidelines. This partnership is also aimed at mitigating the carbon footprint associated with asthma care. 

Since the inception of SENTINEL in 2020, participating primary care networks (PCNs) — originally just six — have prescribed over 44,000 fewer SABA inhalers than they would have if prescribing patterns had remained unchanged, translating into a saving of approximately 1,240 metric tonnes of CO2 equivalent.8

SENTINEL is now being implemented in more than 300 PCNs across the UK,9 and we hope there will be many more by the end of this year. In delivery and through evidence, the incredible team in Hull has showcased a remarkable triumph: the ambitious yet achievable goal of reducing the carbon footprint that results from treating respiratory conditions, while helping to improve asthma care.

People with asthma who consume three or more blue inhalers per year account for 83% of SABA usage, resulting in over 250,000 tonnes of CO2 emissions annually

Fostering partnerships for a sustainable future

SENTINEL exemplifies how companies can partner with the NHS in the pursuit of positive outcomes for patients and the environment. New, proactive, value-based models of care with a focus on prevention offer massive opportunities to help improve patient pathways and outcomes while reducing and eliminating carbon emissions.

Beyond respiratory care, another example is the AstraZeneca sponsorship of the Newcastle upon Tyne Hospitals NHS Foundation Trust and the Sustainable Healthcare Coalition in developing an In-centre Haemodialysis Carbon Calculator (ICHD) to enable hospitals to assess their haemodialysis units’ carbon footprint.

This tool allows hospitals to make their haemodialysis service more sustainable and to understand the savings that could be achieved by early detection and secondary prevention of chronic kidney disease (CKD). We hope adopting this calculator will trigger the next wave of partnerships with the aim of improving outcomes and reducing the carbon footprint across the CKD treatment pathway.

We are committed to driving meaningful change in healthcare, and we are excited to collaborate further to support the NHS in reducing carbon emissions not just in asthma and CKD care but also across other disease areas.

Learn more at

GB-46347 / Date of preparation June 2023

[1] IPCC. Global Warming Special Report. Global Warming of 1.5° Available at Last accessed June 2023
[2]Greener NHS. National ambition. Available at: Last accessed June 2023
[3]S26 An assessment of short-acting β2-agonist (SABA) use and subsequent greenhouse gas (GHG) emissions in five European countries and the consequence of their potential overuse for asthma in the UK. Available at Last accessed June 2023
[4]Janson C, Menzies-Gow A, Nan C, Nuevo J, Papi A, Quint JK, Quirce S, Vogelmeier CF. SABINA: An overview of Short-Acting β2-Agonist use in asthma in European countries. Adv Ther. 2020;37(3):1124-1135
Reddel HK,FitzGerald JM,Bateman ED, et al. GINA 2019: a fundamental change in asthma management. Eur Respir J 2019;53:1901046
[6]Primary Care Respiratory Society. Focus on asthma: The GINA Approach to Managing Asthma. Available at Last accessed June 2023
[7]SENTINEL Plus. Partnering to improve patient outcomes. Available at Last accessed June 2023
[8]NHS and Government back AHSNs to continue to lead innovation, under new name. Yorkshire & Humber AHSN. Available at Last accessed June 2023
[9]Transforming Lives Through Innovation Impact Report 2022-23. Yorkshire & Humber AHSN. Available at Last accessed June 2023

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