Turning Knowledge into Action

Commit to Real Zero’s 7 acts to make an individual difference 

1. Move your money  - to a bank that does not invest in fossil fuels
2. Move your power supplier – to a 100% renewable source  
3. More plant-based – choose food that can sustainably feed the global population without destroying land & biodiversity, and create and protect green spaces
4. More green travel – reduce flying, and choose trains or video conferencing, reduce car use and choose public and active travel options
5. More pre-loved – reduce consumption and waste, buy less, re-use, repair and recycle
6. Measure your CO2e – to motivate you to make changes
7. Motivate others – talk about changes you make and encourage others to commit to these 7 acts, use your voice and your vote to demand action on climate change 

Alternatives: 

• 9 things you can do about climate change
• Make a 1,2 or 5-year plan to stop using fossil fuels for your energy, transport, cooking and heating
• Take the Hippocratic oath for the Anthropocene
• Read this Lancet article on social tipping elements by the health community.

Some actions are more challenging than others, and they may not all be accessible to everyone at this time. Making small, regular progress towards your principles adds up over time. Some, such as active travel, more plant-based food, and using non-fossil fuel heating and cooking methods, can have immediate and long-term health co-benefits for you as well.

Next we will consider opportunities to implement sustainable respiratory care practices. If you’re not familiar with The Principles of sustainable respiratory care and SusQI, then skip back to that section first.

Key actions

• Incorporate prevention into routine clinical care
• Review patient pathways to identify waste and poor care co-ordination to improve efficiency and patient experience
• Choose low carbon medications and technologies wherever possible
• Support and empower patients to self-manage
• Work collaboratively to ensure long term change  

Prevention is one of the pillars of sustainable healthcare. Incorporating prevention into all stages of patient care is good clinical care and is within the competence of every healthcare professional. 

Lifestyle medicine is a way to structure and apply evidence-based approaches to prevention for all patients.

A healthy, plant-rich diet may help reduce inflammation, support immunity, and maintain a healthy weight—factors that are important for lung health. Reducing processed foods and eating more fibre-rich fruits, vegetables, legumes, and whole grains can make a big difference.

Diet resources

• Read Advice from Asthma and Lung UK: Eating well  
• Read the NHS Eatwell Guide  
• Read the Specific guide for airway diseases from Plant-based Healthcare Professionals  

Learn the key facts

If you want to learn more, start with the Royal College of Physicians report, "Every breath we take: the lifelong impact of air pollution," executive/6 page summary. 

Access key facts and useful infographics about the impacts of air pollution across the life course and organ systems. Find suggestions of what we can do to tackle air pollution as individuals, clinicians, researchers, and trusted voices in our communities.

Take action

Incorporate information about the impacts of climate change on respiratory health into patient information

• How Air pollution affects your lungs, including lung cancer | Asthma + Lung UK
• Lowering your risk from air pollution | Asthma + Lung UK
• Indoor air pollution and allergies | Asthma + Lung UK
• Hot weather and your lungs | Asthma + Lung UK

Air pollution and the changing climate are leading to hotter summers and longer pollen seasons, affecting lung health. If you'd like to learn more about how climate change affects our breathing and what actions we can take, the link below is a good starting point.

The European Lung Foundation lists some useful health and climate facts.  

Air pollution can worsen breathing conditions such as asthma and COPD. You may notice more symptoms on days when pollution levels are high. We encourage you to check local air quality forecasts so you can take steps to protect yourself.

• Check local pollution levels  
• Advice on reducing exposure  

The Clean Air Checklist

Download the Action for Clean Air checklist and save or print it to share with a patient during your next consultation. 

This is a practical way of bringing discussions about air pollution and climate change into your consultations. Provides concrete actions your patients can take to protect themselves and reduce their contribution to air pollution as well.

Exploring Air pollution with patients

Ask

• about triggers/possible reasons for uncontrolled asthma before adjusting medications, including environmental factors (for example air pollution, indoor mould exposure).

Advise

• that indoor and outdoor pollution can worsen symptoms and trigger exacerbations
• that there are actions people can take to reduce exposure 
  

Act

• include approaches for minimising exposure to air pollution and any other personal triggers in the personalised action plan, with links to further information like the information from NICE on outdoor air quality and health and indoor air quality at home
• offer patients information leaflets about air pollution (Clean air hub's information for adults or information for children) 
• offer patients action for clean air checklists about how to reduce exposure to air pollution (adults or children) 
• write a letter to your MP advocating for the treatment of damp and mould in social housing

Messaging to patients 

Make your messaging relevant by linking air pollution, heat stress, allergens, or damp housing to health conditions:

Advocate for clean air 

• Hold a clean air day event  
• Start an anti-engine-idling campaign   
• Propose that air pollution is added to your trust’s risk register, so that your trust is made aware of, and takes action to tackle, the risk that air pollution presents to staff, patients and visitors on your hospital site. Develop a Clean Air Plan like Guy's and St Thomas' hospital.

Do you provide your patients the best possible support to quit smoking?

Become a qualified smoking cessation advisor by taking the free course on the National Centre for Smoking Cessation website 

Does your hospital provide the best possible support to quit smoking?

Read and implement the BTS recommendations for hospital Smoking Cessation Services.

Vaccination is a high value intervention for all patients living with respiratory disease as it reduces the risk of severe exacerbation.

Useful resources to promote vaccine uptake are available from the UK Health Security Agency website.

Other interventions to reduce exacerbations in specific patient groups are based on providing the best clinical care: this may include:

• treating tobacco dependence
• macrolides in bronchiectasis or COPD patients with frequent exacerbations
• biologics in severe asthma,
• immunosuppression or antifibrotics in ILD.

High-quality proactive clinical care that prevents disease is also low-carbon care. 

Many current healthcare pathways and ways of working are inefficient and wasteful. Lean care pathways eliminate waste in resources, energy, and time to improve efficiency, reduce the carbon footprint and plastic waste, and ensure economically viable services that promote both patient and staff well-being.

The GIRFT (Getting It Right First Time) programme is not explicitly a sustainability programme, but it provides a wealth of data and ideas on best practice. 

Other examples of opportunities to implement lean pathways are shown in the table below

Opportunities to implement lean pathways

Look around at your department, and accepted norms. Start asking questions and challenging the rationale for current practice.

1. Audit – map your current practice (number of ABGs, repeat allergy or Quantiferon tests, bronchoscopy or pleural  kit waste, glove usage, O2 left running)
2. Prioritise high-waste areas with low/minimal clinical value. Apply Choosing Wisely principles
   eg No routine bronchoscopy for haemoptysis or Unnecessary ABGs in COPD patients
3. Intervene – Follow ABG guidelines,   don’t open things “just in case they’re needed”, re-use of MDI inhalers in the lung function lab (see QI section), explore recycling options
4. Evaluate and share – measure waste avoided, convert to CO2 or money saved where possible, share success.

The priority for any patient on inhalers is that their disease is well controlled. This is best achieved by following the latest NICE/BTS/SIGN and local guidelines. Here are some key considerations when focusing on environmental sustainability.

Reducing gas-related emissions and devices

Accurate Diagnosis 

• Asthma is frequently over-diagnosed; de-escalation of unnecessary asthma treatments reduces waste and helps patients avoid side-effects.
•  Bronchodilators are often prescribed, but are ineffective for symptomatic smokers or ex smokers who don’t have airflow obstruction on spirometry
• Inhaled steroids only benefit a subset of patients with COPD (those who have exacerbations and higher blood eosinophils), but patients with severe disease are often escalated to inappropriate high-dose ICS

Medication and Device

• Make sure your hospital has a range of DPI and MDI options available, so the right device can be made available.
• Consider whether you or your department need to work on inhaler technique knowledge and skills.
• Every patient should have inhaler technique assessed, the right device selected in a shared decision-making approach, and ongoing support to maintain optimal technique.
• For asthma, choose SABA-free regimes (AIR/MART) for appropriate patients, and prioritise a DPI, LABA/ICS where patients can use these devices effectively
• Recommend DPIs and SMIs over MDIs whenever patients can use these devices effectively
• For patients on a stable dose using MDI, review whether fewer puffs of a higher dose inhaler can be used (maintains dose delivered but reduces propellant use)
• Choose the lowest environmental impact inhaler among suitable devices
• Prioritise devices with an integral dose counter 

Propellant 

• Avoid inhalers with the highest carbon footprint due to use of HFA-227ae as the propellant (Flutiform MDI and Symbicort MDI). In most cases a suitable alternative is available.
• For patients remaining on MDIs, choose low-carbon MDIs as they become available. The first low-carbon pMDI using an HFO-1234ze(E) propellant was approved for use in the UK in 2025 (Trixeo)
• For patients remaining on SABA MDIs choose those with a low volume of propellant (Salamol or Airomir) over those with high volume (Ventolin) 

Oxygen

• Piped “wall” oxygen is cheaper and has a lower carbon footprint than O2 from cylinders.

Effective self-management helps patients maintain control of their own disease, fosters confidence and independence, could help prevent complications by intervening earlier, and hence reduces the environmental impacts of care.

Key components include

• Education and Skills: Providing clear, personalised information about their condition and its treatment.
• Peer Support: Fostering connections with others living with similar respiratory conditions for shared experiences and motivation.
• Action Plans: Co-created, personalised plans for recognising and responding to worsening symptoms.
• Family and Carer Involvement: Engaging support networks to reinforce self-management strategies.
• Breathlessness Management Techniques: Teaching pacing, breathing exercises, and relaxation methods.
• Digital Technology: Using apps like myCOPD and online resources to support learning, monitor symptoms, and track progress.
• Timely Access to Help: Ensuring patients know how to seek professional advice promptly when needed.

Empower, don’t overwhelm: share positive actions they can take.

Use existing tools: e.g. Asthma + Lung UK patient leaflets, NICE inhaler decision aid.

Read about how to make your service more sustainable in our From Literacy to Leadership section