Where is the inhaler?

Abstract

Aim

Inhaler devices, used for asthma and COPD treatment, have environmental impacts associated with their manufacture, the hydrocarbon propellants some inhalers contain, and their disposal as pharmaceutical waste. Replacement of misplaced inhalers has environmental, workload and financial implications. This study aimed to explore the extent asthma/COPD inhalers dispensed to inpatients are re-supplied.

Methods

All asthma/COPD inhalers dispensed to inpatients (including on discharge) in 2023 were identified from the Austin Health Merlin dispensing system. The incidence of supply of more than one of the same inhaler per patient per month was determined, and the cost and carbon footprint of the additional supplies were calculated.

Results

345 (9%) of 3957 inhalers dispensed to inpatients in 2023 were supplied to the same inpatient more than once within the same month. Based on a mean of $35/inhaler, the cost of 345 additional inhalers is ~$12,000, and the carbon footprint up to 9700kg CO2e, depending on the inhaler supplied. If the 9% re-supply rate is extrapolated to all inpatient inhalers supplied (n=11,512, including via the ward imprest, mean cost $18/inhaler), estimated re-supply costs are an additional ~$18,000, associated with up to 28,200kg CO2e1 (~13 laps around Australia in a light SUV2).

Discussion and conclusion

Inhalers last one month at standard doses, so re-supply within a month suggests replacement of missing inhalers. Some patients may be hospitalised for lengthy periods, require higher doses or have multiple admissions, justifying multiple supplies. Nevertheless, the re-supply rate is likely underestimated because dispensings within adjacent months were not included and inhalers supplied from ward imprests are potentially re-supplied more often because these are not formally labelled and are therefore more easily misplaced.

Impact

Re-supply of inhalers has substantial environmental, staff workload, waste and financial implications. Awareness must be raised, and strategies implemented, to ensure that inhalers are not re-supplied unnecessarily.

Reference

Carbon footprint calculated using figures at: https://cascadescanada.ca/wp-content/uploads/2022/07/CASCADES-INHALER-PLAYBOOK-FINAL_EN.pdf Accessed 29/05/24

Carbon emissions for a light SUV calculated using: Carbon Dioxide Emissions Intensity for New Australian Light Vehicles 2021. National Transport Commission. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ntc.gov.au/sites/default/files/assets/files/Carbon%20Dioxide%20Emissions%20Intensity%20for%20New%20Australian%20Light%20Vehicles%202021.pdf. Date accessed: 22/05/24