Last Modified: 5:52pm 05/10/2022

Inhalers: Environmentally friendly disposal

How to help the environment by returning inhalers (and any other medicines waste) to a community pharmacy

In October 2020, the NHS announced its ambition to become the world’s first healthcare system to commit to reaching net carbon zero. This commitment was made in response to the profound and growing threat to health posed by climate change.

The NHS is the largest employer in Britain and is responsible for around 4% of the nation’s carbon emissions, with a carbon footprint of 18 million tonnes CO2 per year. The NHS must play a major role in leading a reduction in carbon output whilst maintaining and improving health outcomes both nationally and locally.

A small number of medicines account for a large portion of the NHS emissions, and there is already a significant focus for action on two such groups – anaesthetic gases for surgical operations (2% of NHS emissions) and inhalers for respiratory conditions (3% of NHS emissions) – where emissions occur at the ‘point of use’. The use and environmentally safe disposal of inhalers in particular is a specific focus for the NHS over the next few years in reducing its carbon footprint.

Focus on inhalers

The use of inhalers accounts for approximately 3% of the NHS’ total carbon footprint.

Chlorofluorocarbons (CFCs) that directly damage the ozone layer were phased out, but Meter Dose Inhalers (MDI) or “puffers” still contain a hydrofluorocarbon (HFC) propellant which is released unchanged into the atmosphere and acts as a potent greenhouse gas. The UK has a reliance on MDIs – they make up 70% of inhaler prescriptions which is higher than other European countries – and NHS action on that is occurring nationally.

A very high proportion of inhalers get put in the bin and go to landfill where any residual propellant gas inevitably leaks out into the atmosphere. The release of remaining propellant can account for up to 25% of the life-cycle CO2 emissions of an inhaler. As well as the gases released, the plastic is generally not recycled which further adds to the carbon footprint. Inhalers are a frequently prescribed and vital treatment, making it one of the key areas that we want to target to better understand how we can safely prescribe, use and dispose of inhalers in the most environmentally friendly way possible.

Understanding the impact of inhalers on the environment

From October 2021 – January 2022, members of the Trust’s Paediatrics team conducted two separate surveys; one directed at MKUH colleagues across the Trust, the other at paediatric patients, parents and carers. The aim of these surveys was to understand the awareness that these groups had on the environmental impact caused by inhalers to identify how and where we can support.

The majority of staff responding (61%) said that they were not confident in their knowledge of the environmental impact of inhalers. Moreover, staff were unaware of the sustainable ways to dispose of inhalers, with 36% unable to name any potential methods for disposing of an inhaler responsibly and less than 20% stating that they routinely advise patients and caregivers on how to dispose of their inhalers.

Of the parents and carers surveyed, almost 50% had a child who had used an inhaler for five or more years. Most of all responders (69.4%) said they dispose of their inhalers in the general waste, with only one parent recalling that they had ever been given advice on how to dispose of their child’s inhaler.

Unsurprisingly, the overwhelming majority of parents responding want to help with ensuring that inhalers are delivered, distributed and disposed of in an environmentally friendly way. 88.5% would like to have more information on responsible disposal of inhalers, with 98.4% stating that they would use a recycle point if it were available to them.

All inhalers, even non-MDIs, and other medicines waste from home should be returned to a community pharmacy for disposal to remove potentially harmful waste from the community and promote recovery of recyclables.

Actions we are taking on Inhalers at Milton Keynes University Hospital

Following the insights gathered as part of our surveys, and in-line with our commitment to be net carbon zero by 2030, we are working on several initiatives to improve staff, patient and parent knowledge of the safe disposal of inhalers. These include:

• Providing education for staff on the environmental impact of inhalers, so they in turn can have the confidence to advise patients on safe disposal
• Pharmacy staff adding clear information about inhaler and medicines disposal to dispensed medicines packs for patients
• Putting up key information posters in clinical areas for staff and patients
• Delivering advice to patients online via our website
• Working with GPs across the Integrated Care Services interfaces
• Disseminating our insights to other NHS trusts to improve their awareness

What you can do about inhaler disposal

As part of our ambitions to reduce carbon emissions, we need the support of all of our staff, patients, visitors and the local community. Small changes can make a huge difference and the safe disposal of inhalers will go a long way to reducing our carbon footprint. You can help by returning all used inhalers to your local community pharmacy where they will be disposed of with other waste medicines. Metal canisters are then incinerated to destroy the greenhouse gases and recover the metals, with the plastics recycled.

Reducing harmful carbon emissions helps improve health and the quality of life of our communities. All medicines waste from home should be returned to a community pharmacy for disposal to remove potentially harmful waste from the community and promote recovery of recyclables.

For further information about inhaler use and all of our other initiatives to reduce our carbon emissions as part of our Green Plan here.