I recently heard about this fantastic project, which won an innovation and best practice award at PrescQIPP, and the authors kindly agreed to me sharing it here. I really hope it can provide both inspiration, and some useful resources, for others trying to improve inhaler return rates and/or implement inhaler recycling.
In 2024, South East London (SEL) ICS launched England’s first fully NHS-funded, ICS-wide inhaler recycling project. Running across 20 community pharmacies and all five acute and mental health trusts in SEL, the pilot is fully integrated across primary and secondary care. The public can return used inhalers to any participating site, where they are separated from regular medicines returns and sent for 99.9% component recovery—including aluminium, plastic, and residual HFA gas.
The scheme uses existing NHS clinical waste infrastructure, including contracts with PHS Group and Grundon Waste Management, to implement a new disposal route for pressurised metered dose inhalers (pMDIs). Community pharmacies collect pMDIs in specially designated bins, and acute trusts have bins in respiratory clinics, wards, and outpatient pharmacies. Inhalers are safely transported to Grundon for specialist recovery.
Posters, stickers, and digital surveys were co-designed with patients to encourage correct disposal. Monthly data reporting tracks return rates and will support a full NHSE-led evaluation in 2025/26. In a recent update from the project lead, as of 14/10/25 – approximately 18,000 inhalers have been collected!
This innovative project shows inhaler recycling can be embedded in existing NHS systems. It presents a replicable and scalable national model, supporting medicines optimisation, waste reduction, and sustainability. The pilot’s outcomes will inform future commissioning and advance the NHS’s Net Zero goals.
You can find out more, and access some of the resources (including stickers reminding people to return their inhaler to a pharmacy for disposal - so even if recycling is not an option for your area currently, you could improve return rates which still has a positive environmental impact!) here: https://www.selondonics.org/our-residents/your-health/local-nhs-services/inhaler-return-and-recycling/
That sounds really frustrating Debs, looking at the regulation they are required to accept back unwanted medications from individuals (not necessarily from GP practices and nursing homes), and NHS England organise and pay for this: https://cpe.org.uk/national-pharmacy-services/essential-services/dispos…. Perhaps you could try mentioning this to them and see what they say. Thank you for trying!
Jennifer Nixon if the yellow bin for returned medicines is full, as is often the case, then pharmacies can NOT accept any returns. Storing returned medicines in say a cardboard box will be a breach of contract, ethically questionable and professional suicide if the pharmacy inspector arrives.
The problem being the bins are small for a reason due to space, and all it takes is 1 elderly patient to pass away and then bin bags full of medicines are dumped on the pharmacy filling the yellow bin. The contract for yellow bin emptying, as correctly pointed out, is with the NHS and not the pharmacy. It could then be weeks or months before the bin is then collected.
Remember, returning inhalers to virtually all pharmacies is not recycling, they get sent for high temperature incineration, at least the HFAs are denaturised
Garry McDonald thank you so much for explaining this. This is why working together with colleagues is so valuable, as I had no awareness of the financial side of this, and the conflicting situation that whilst the NHS states pharmacies must accept returns, they don't provide frequent enough collections to facilitate this. I apologise if this is coming from a totally naive position, but is your local waste contractor able to help with more frequent collections (as it states on the article above that "Pharmacy owners should contact the NHS appointed waste contractor regarding any queries related to the collection of waste. Your Local Pharmaceutical Committee or the local NHS contract management team will be able to provide the contact details of the waste contractor." Again apologies if it is not as simple as that, I just wanted to ask.
I am sorry to hear you are in such a difficult position. I totally appreciate and agree that we cannot expect pharmacies themselves to pay for recycling (and I am not aware of any that have (though please let me know if I you are)). The above scheme was NHS-funded across the ICS, who also appear to have centrally organised the waste collections. However unless inhalers are returned somewhere, we will never see enough input for a large-scale/national recycling scheme to be viable. And of course even if they can't be recycled, correct incineration via a pharmacy is much better than household disposal. So we need to make it feasible for pharmacies to accept inhalers (for incineration currently, unless your local ICS offer recycling) and educate patients to return inhalers to pharmacies (so they can correctly disposed of now, and so that we have a process/inflow of inhalers in place for if/when recycling is available).
And whilst low carbon MDIs are an important step, we aren't going to see every drug and every patient switch overnight, and we know that for many DPIs are actually the most suitable type of inhaler/inhalation technique for them, so I still think we need safe and sustainable disposal streams for all.
Jennifer Nixon the crux in England is ICB funding of any services. Here in Scotland we don't have ICBs nor do we have any commissioner level, it's a national contract negotiated and agreed nationally not locally at ICB level.
My personal stance is that like batteries, if you sell them as a retailer, you have to offer facilities to return and recycle. Using that legal point with inhalers to leverage funding for recycling and a public awareness that all inhalers not just MDIs need to be returned for either recycling or destruction.
I have seen too many asthmatics and COPD patients blanket switched to DPIs without being seen or inhaler technique checked. Stable and well controlled patients now exacerbating just to satisfy a financial carrot 🥕 in the IIF back in the day. The carbon footprint of just 1 night in A&E is the equivalent of 10 Salamol MDIs, the average number if bed days for an asthma attack is 3 and for COPD it's 7 bed days, 70 inhalers worth of carbon when the patient can't use a DPI correctly.
We already know that an uncontrolled asthmatic has a carbon footprint 300% that of a well controlled. ICBs should be funding and focusing on better control, this after all is patient centred care not financially incentivised switching.
On a dark humour note, I contacted the NAFD (National Association of Funeral Directors), when we get it really wrong and the patient dies of an asthma attack, the average carbon footprint of a funeral ⚱️ in the UK is the equivalent of 40 Salamol inhalers. Those with no friends will obviously be considerably lower lol
The patient has to win for the planet to win, that after all is true patient centred healthcare
Hi Garry
Again, so useful to speak to colleagues in every discipline and in every nation, to understand all the different challenges.
Absolutely agree with the ‘polluter-pays’ principle, would love to see that happen, but don’t think we can wait the companies to do it themselves, we need to create the demand.
And yes completely oppose blanket switching, absolutely patient care must come first, and absolutely agree that the most important thing is good disease control – I am not disagreeing with you on any of these points. For some patients, their inhalation technique is more suited to DPI than MDI, and others MDI (+ spacer) over DPI – it has to be what the patient can use effectively.
In the 4 principles of sustainable healthcare, Prevention always come first. In the example of inhalers, that would be both preventing someone developing asthma or COPD in the first place (eg through adequate smoking cessation services, improved air quality etc) and then if they do develop asthma or COPD, preventing exacerbations through optimal control. However the other 3 principles (patient empowerment, lean pathways, and low carbon alternatives) are still important. So while I completely agree that our number one focus should be optimal disease control, given the scale of the climate crisis we cannot afford to leave any stone unturned in our mission to improve patient and planetary health.
Thank you for your really useful insights.