Understanding the feasibility and environmental effectiveness of a pilot postal inhaler recovery and recycling scheme

The study addresses the problem that most inhalers are not recycled and are often disposed of via domestic waste, contributing to greenhouse gas (GHG) emissions, particularly from the fluorinated propellants in pressurised metered-dose inhalers (pMDIs). With inhalers contributing to NHS carbon emissions and HFC propellants having high global warming potential, and given limited existing recovery systems and low public awareness of appropriate disposal, the research question was whether a postal, pharmacy-facilitated scheme to recover and recycle inhalers is feasible and environmentally effective. The purpose was to divert inhalers from household waste, recover materials and propellant, and estimate carbon savings, aligning with NHS Net Zero goals. The importance lies in reducing GHG emissions from inhaler disposal while maintaining access to diverse inhaler options for patient care.

Background highlights include: wide variation in inhaler type use by country (e.g., 70% pMDIs in England vs 13% in Sweden), and surveys indicating most patients dispose of inhalers in household waste. pMDIs use HFC134a and HFC227ea propellants with ~1000–3000× CO2 global warming potential; F-gases account for ~2% of global GHG emissions. NHS Net Zero plans include greener inhaler disposal and increased DPI use. Prior industry schemes were largely pharmacy drop-off models (e.g., GSK’s ‘Complete the Cycle’ and Teva’s program), but public data on their current status are limited. These contexts informed testing a postal-return alternative to improve recovery and reduce emissions.

Design: Chiesi conducted desk-based research into recycling schemes, patient views, potential carbon savings, and operational processes, then established a multidisciplinary steering group across the Leicester, Leicestershire, and Rutland (LLR) health system. All 227 community pharmacies in LLR were invited (voluntary, no financial incentives) and later three hospitals in the University Hospitals of Leicester (UHL) NHS Trust were added. Intervention: Participating pharmacies discussed the Take AIR scheme with patients and provided pre-paid, pre-addressed Royal Mail tracked envelopes (up to four inhalers per envelope; any brand/type). Patients removed personal identifiers, inserted up to four used or unwanted inhalers, sealed, and posted the envelopes. Logistics and processing: Envelopes were sent directly to Grundon Waste Management Ltd. Contents were sorted into recyclable vs non-recyclable streams. For pMDIs: aluminium canisters were crushed for smelting; remaining propellant was extracted and recycled for use in refrigeration/air conditioning; single-polymer plastic casings (actuators without dose counters, and dust caps) were pelletised for recycling. Non-recyclable items (DPIs, SMIs, and pMDI canisters with integrated dose counters/valves) were incinerated in an energy-from-waste facility. Data collection: Operational data were collected weekly and aggregated by month from 15 Feb 2021 to 18 Feb 2022, including number of pharmacies enrolled, envelopes distributed/returned, and inhalers received, by type. Modelling of carbon savings: Predictive modelling estimated residual propellant mass per returned pMDI using manufacturer overfill assumptions and factors such as propellant type (HFA134a or HFA227ea), cosolvent content, dose count, leakage over shelf life, and tolerances (filling, valve, non-accessible volume, equilibrium maintenance, test actuations, dose counter accuracy). Assumptions: pMDIs were used to label claim, not beyond, and stored per instructions; the model excluded partially used/unused devices and those well past expiry. Conversion of F-gas mass to CO2e used the UK government online tool; public-facing equivalences used the US EPA calculator. Patient feedback: A voluntary, anonymous online multiple-choice survey was accessible via QR code in envelopes; no active recruitment was undertaken.

- Participation: 148/227 pharmacies (65%) and UHL Trust (3 hospitals) enrolled; 76% of sites enrolled within the first two weeks. - Envelopes: 14,805 envelopes delivered; 5,686 envelopes returned via Royal Mail during the 12 months. Monthly returned envelopes increased seven-fold, from 149 (Mar 2021) to 1,041 (Jan 2022). - Inhaler returns: 20,049 inhalers received (mean 3.5 per envelope), averaging 386 per week, ≈2% of all inhalers prescribed weekly in LLR (based on 20,179.6 prescribed per week). Returns rose from 451 (Mar 2021) to 2,906 (Jan 2022), ≈3.3% of monthly prescriptions by end of period. - Inhaler types: 77% of returned devices were pMDIs; monthly pMDI share ranged 67–82%. - Carbon impact: Minimum estimated savings of 119.3 tonnes CO2e over 12 months (conservative, based on manufacturer overfill only; excludes residual from partial use). Equivalent to sequestration by 1,973 tree seedlings grown for 10 years or 141 acres of US forest in one year. - Patient feedback (n=49; 48 completed): 94% (45/48) joined due to environmental concern; 90% (44/49) were satisfied/very satisfied; 100% (49/49) found instructions easy/very easy; 100% (48/48) supported national rollout.

The pilot demonstrated that a postal inhaler recovery and recycling scheme is feasible and environmentally effective. Rapid pharmacy uptake and steadily increasing patient returns suggest normalization of behavior over time and potential for sustained use. The scheme diverted inhalers from domestic waste, enabled material recovery, and reduced GHG emissions by reclaiming residual propellants from pMDIs. Positive patient feedback indicates convenience and acceptability, supporting broader adoption. Comparisons with prior pharmacy drop-off programs (GSK, Teva) and other take-back initiatives (e.g., insulin pens, consumer products) suggest appetite for nationwide schemes and opportunities to optimize return rates by offering both postal and drop-off options. Education integrated throughout the care pathway could further improve appropriate disposal, inhaler technique, and adherence, indirectly reducing emissions by decreasing medication waste. While transitioning to lower-GWP pMDI propellants (e.g., HFA-152a) is forthcoming, not all pMDIs may convert; thus, effective disposal and recycling will remain necessary. Multi-stakeholder collaboration (NHS, local councils, pharma, waste partners) will be essential to scale the program and address regulatory and logistical complexities.

Take AIR provides proof of concept that a postal inhaler recovery and recycling scheme can be implemented at scale within a region, achieve high engagement from pharmacies and patients, and deliver measurable GHG emission reductions by reclaiming propellants and recycling materials. The initiative offers a practical pathway to support NHS Net Zero goals and reduce the environmental impact of inhalers without compromising patient choice. Future directions include national scale-up, integrating postal and drop-off options, embedding patient education earlier in the care pathway, refining data capture (e.g., weighing returned devices to quantify partial use), and aligning with the introduction of low-GWP propellants to maximize overall climate benefits.

- Generalisability: Pilot limited to one UK region (LLR) and 12 months; scalability and long-term sustainability require further evaluation. - Carbon modelling assumptions: Estimates based on manufacturer overfill and correct use to label claim; excludes residual propellant from partially used/unused devices and those past expiry, likely underestimating savings. - Comparative data gaps: No publicly available data on volumes returned via existing pharmacy drop-off schemes; unable to compare postal versus drop-off effectiveness. - Operational constraints: Regulatory, waste-transfer, and postal carriage requirements were complex; envelope capacity limited to four inhalers to mitigate risk. - Recycling scope: Not all devices/parts were recyclable (e.g., DPIs, SMIs, integrated dose counters) and were incinerated for energy, contributing some emissions. - COVID-19 context: Pandemic may have affected pharmacy capacity and patient engagement. - Survey: Small, self-selected respondent sample limits generalisability of patient feedback.