Reducing the environmental impact of respiratory care across NHS Lothian

NHS Lothian recently led a project to reduce waste and carbon emissions caused by incorrectly disposed inhalers.

Across Scotland, respiratory disease is common, however the treatment for this is a major carbon hotspot. Emissions caused by incorrectly disposed inhalers contribute to air pollution, potentially exacerbating respiratory conditions and affecting the overall health of our communities.

Jane Hopton, NHS Lothian Environmental Sustainability Lead said: “The carbon footprint of respiratory disease is largely due to the current propellant gases found in some inhalers. These gases have 1,430 or 3,220 times the global warming potential of CO2, depending on the brand of inhaler. 

“By disposing of used, unwanted, or expired inhalers properly, we can ensure the safe destruction of the residual propellant gases and in doing so, help to reduce their carbon footprint.”

This project, which was funded by NHS Lothian Charity as part of their Climate Challenge Grant initiative, asked participating community pharmacies to add stickers to dispensing bags containing inhalers. The stickers stated, “please return unwanted or expired inhalers to your pharmacy for environmentally safe disposal.” 

In total, five community pharmacies took part in the pilot project. After 10 weeks of adding the stickers to bags, the number of inhalers returned was four times more than prior, representing a 300% increase. 

Jane added: “This has been an important project, and one which demonstrates how small changes can make a valuable contribution to supporting our sustainability goals.

“Our thanks go to staff within the Community Pharmacies that were involved for their support in making this pilot such a success. I look forward to seeing this work develop, as collectively we explore all opportunities to reduce our carbon footprint.”

While dry powder inhalers do not contain propellants, they are currently not recyclable due to the multiple types of plastic and components in them. Patients, however, are encouraged to dispose of these items safely and can return them to a pharmacy to do this.

The second phase of this project aims to increase effective prescribing for respiratory conditions by improving access to information that supports clinical decision making and promotes good inhaler techniques.

This is in recognition of the new Scottish Government quality prescribing strategy for respiratory conditions which recognises that the most environmentally friendly inhaler is one that patients can, will and do use correctly.

Resources have been developed to support this, including posters for healthcare staff and educational posters to support patients with their inhaler technique. These have been distributed to staff in primary and secondary care by the Respiratory Managed Clinical Network. 

Katie Johnston, Respiratory Lead, Primary Care Pharmacist, NHS Lothian said: “Lots of people use inhalers and often do not think about the environmental impact these can have. 

“Community pharmacies are ideally positioned and essential to support improved respiratory care and to help reduce the environmental impact of all medicines.

“Feedback regarding the resources has been very positive and the Managed Clinical Network plans to continue to develop and share information to ensure inhaler waste continues to be reduced, the carbon footprint from inhalers is minimised and every patient is prescribed an inhaler device that is suitable for them.”