Patients should be encouraged to return their used or expired inhalers to community pharmacies for appropriate disposal, recent NHS green guidance has instructed.

Meanwhile, inhaler choice should take into account clinical appropriateness, the environmental impact of inhalers and patient preference; while inhaler use and adherence should be improved, the framework said.

And overprescribing and oversupply of medicines should be addressed, while still supporting patients in greatest need, the guidance published by NHS England earlier this month added.

It highlighted that medicines account for around 25% of NHS emissions, including 3% of total NHS emissions that comes from inhalers.

And it suggested that healthcare systems might keep track of progress towards this goal by tracking:

  • Average inhaler emissions per 1,000 patients
  • The mean emissions of Short-acting beta-2 agonists (SABAs) inhalers prescribed
  • The percentage of non-SABA inhalers that are MDIs (Metered Dose Inhalers)

New NICE guidance on asthma published in November set out that the use of short-acting beta agonist (SABA) inhalers alone should be replaced by the use of combined inhaled corticosteroid (ICS)/formoterol inhalers.

And in a recent survey of 200 patients, 55% who were using inhalers without a dose counter said they could not confidently assess when their device was empty.

Among more than 2,600 pressurised metered-dose inhalers that had been returned for recycling, many were returned under or overused, the same study found.

Almost 70% of patients surveyed also said they had thrown unwanted inhalers away in household recycling or waste and more than half just threw them away when done with them whether empty or not.

Pressurised Metered Dose Inhalers (pMDIs) currently use hydrofluorocarbon gases (HFCs or ‘F-gases’) as propellants.

These potent greenhouse gases stay in the atmosphere for approximately 270 years and account for 96% of the climate change impact of inhalers.

And when pMDIs are disposed of in domestic waste, the residual HFCs are likely to be released into the atmosphere when the inhalers are crushed by refuse lorries or in landfill.

In July, community pharmacies in south-east London launched what is believed to be England’s only nationally-funded inhaler recycling pilot.

It uses Grundon Waste Management’s inhaler recycling technology.

A similar pilot run in Leicestershire in 2021-22 saw 52,148 inhalers returned through the post over a 24-month period. This saved an estimated equivalent of 305.3 tonnes of carbon dioxide emissions entering the atmosphere.