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

The environmental impact of inhalers, particularly pMDIs due to their fluorinated propellant gases (F-gases), is significant. Current disposal methods, primarily through domestic waste or community pharmacy clinical waste incineration, are environmentally unsustainable. Existing inhaler recycling schemes, such as GSK's Complete the Cycle and Teva's program, lack sufficient publicly available data on their effectiveness. This study aimed to evaluate the feasibility of a postal inhaler return system as an alternative, focusing on pMDI propellant recycling to reduce GHG emissions. The increasing prevalence of inhaler prescriptions globally underscores the urgent need for sustainable disposal methods. The NHS's Net Zero target highlights the importance of reducing inhaler-related carbon emissions through increased use of DPIs, improved disposal practices, and innovation in low-carbon propellants. The study design was based on market research emphasizing ease of use and convenient access points.

A range of inhaler devices (pMDIs, DPIs, SMIs) are used to manage respiratory conditions, each with advantages and limitations. Patient factors significantly affect inhaler suitability and adherence. The environmental impact of inhalers stems from manufacturing and, especially, from the F-gases in pMDIs, which have high global warming potential. Despite the potential recyclability of inhaler components, most are disposed of in domestic waste due to limited collection systems and patient awareness. Existing pharmacy take-back services often lack specificity for inhalers. The need for greener inhaler options is highlighted by NHS carbon emission reduction targets and calls for pharmacy-based recycling systems by the UK Environmental Audit Committee.

The Take AIR (Action for Inhaler Recycling) scheme, funded by Chiesi, was a 12-month pilot postal inhaler recycling program in Leicester, Leicestershire, and Rutland. 148 out of 227 (65%) community pharmacies and three hospitals voluntarily participated. Participating pharmacies distributed pre-paid, pre-addressed envelopes to patients. Patients could return up to four inhalers per envelope via Royal Mail tracked service. Grundon Waste Management processed the returned inhalers. pMDIs were dismantled, with aluminum canisters crushed for smelting, propellant gas extracted for reuse, and plastic casings recycled. Other inhaler types were incinerated for energy recovery. Data were collected weekly on the number of envelopes delivered and returned, and types and quantities of inhalers received. Predictive modelling estimated propellant content and CO2 emission savings based on manufacturer's overfill. A patient survey assessed satisfaction and willingness for national expansion.

Over 12 months, 20,049 inhalers were returned, with pMDIs accounting for 77%. The number of returned inhalers increased steadily throughout the study period (from 451 in the first full month to 2906 in the last). The scheme resulted in an estimated minimum of 119.3 tonnes of CO2 emission savings. The patient survey (49 responses) indicated high satisfaction (90%) and strong support (100%) for national implementation. Pharmacies showed high voluntary uptake (65% enrollment).

The Take AIR pilot demonstrates the feasibility and effectiveness of postal inhaler recycling for reducing GHG emissions. The gradual increase in inhaler returns suggests behavior change and normalization of recycling. Positive patient feedback supports the potential for national expansion. While previous drop-off schemes (GSK's Complete the Cycle, Teva's program) indicate some success, Take AIR showcases the viability of a postal alternative. Comparisons with other hard-to-recycle product recycling programs highlight the transferability of best practices. Improved patient education about inhaler disposal and the environmental impact is crucial. Efficient inhaler use and adherence can also significantly reduce environmental impact, as can a transition to pMDIs using lower global warming potential propellants.

The Take AIR scheme successfully demonstrates the feasibility and effectiveness of a postal inhaler recycling system. The high participation rates and significant CO2 emission reductions highlight its potential for national-scale implementation. Future efforts should focus on broader stakeholder collaboration, improved patient education, and addressing challenges related to regulatory compliance and waste management logistics.

The study's limitations include its regional scope and duration, the reliance on estimated carbon emissions calculations (assuming correct inhaler use), and the small sample size of the patient survey. The study could not compare postal returns with those via community pharmacies due to a lack of publicly available data on other inhaler return schemes. The impact of the COVID-19 pandemic may also have affected participation.