Chiesi - February 2021 - case study 1

Take AIR (Action for Inhaler Recycling) is a Chiesi Ltd funded scheme supported by University Hospitals of Leicester NHS Trust (UHL) and Leicestershire and Rutland Local Pharmaceutical Committee (LPC).

In February 2021, Chiesi Ltd, UHL and the LPC collaborated to develop Take AIR, the first and only scheme allowing people to dispose of and recycle empty, unwanted, or out-of-date inhalers through the post.

After researching recycling schemes in pharmaceuticals and other industries, it was decided to test the feasibility of a postal model, with pharmacies providing pre-paid, pre-addressed envelopes to patients. Patients then filled each envelope with up to four unwanted inhalers and posted them via Royal Mail post boxes directly to a specialist recycling facility.

All inhaler types could be returned; pMDIs were dismantled, with aluminium canisters crushed and suitable plastic pelletised, ahead of recycling. Remaining propellant gas was extracted for reuse in non-pharmaceutical industries (e.g. refrigeration and air conditioning). Using predictive modelling, carbon emission savings from recycled pMDIs were estimated. Other inhaler types were incinerated at high temperature and converted into energy through a process called energy-from-waste.

Take AIR’s success demonstrates the validity, scalability and sustainability benefits of postal inhaler recycling schemes, providing a model for the NHS to implement similar schemes. These schemes, together with other initiatives across respiratory care pathways, have the potential to significantly reduce the impact of inhalers and their propellant gases on the environment. This is a recommendation as part of the NHS Net Zero plan.

Throughout the project, there was a commitment to sharing the learning and knowledge. As well as the publicly available outputs below, Chiesi continues to have discussions across the UK NHS regarding inhaler recycling schemes:

• Chiesi has developed an Inhaler Recycling Implementation Toolkit that shares the lessons learned from Take AIR so that other UK healthcare professionals (HCPs) can deliver their own schemes. More information for UK HCPs available at: https://www.chiesimedical.co.uk/sustainability-inhaler-recycling/inhaler-recycling/
• Take AIR was described by judges at the 2023 HSJ Partnership Awards as “a brilliant example of a partnership model between the health service and industry” and noted that they “look forward to seeing this project scale further so more citizens can benefit”. It won two awards:
• Environmental Sustainability project of the year
• Best Pharmaceutical Partnership with NHS
• More details available here: https://partnership.hsj.co.uk/winners-2023.

The project team assessed the impact of the first year of Take AIR in this academic article published in January 2023:

• NPJ Primary Care Respiratory Medicine: Understanding the feasibility and environmental effectiveness of a pilot postal inhaler recovery and recycling scheme. Available at: https://www.nature.com/articles/s41533-023-00327-w

Benefits for patients:

The scheme was well received by participating pharmacists: 85% of respondents (n=26) were either ‘very satisfied’ or ‘satisfied’ with it. All patients surveyed (n=76) agreed that they thought the scheme should be available across the UK.

Patient surveys and market research carried out by Chiesi assessed the type of scheme that would be most beneficial for patients. Chiesi also provided project management expertise, working alongside multiple stakeholders, engaging patients, and suppliers to ensure the scheme’s success.

Benefits for NHS:

Across the two years of the scheme (Feb 2021 to Feb 2023) 14,060 envelopes containing 52,148 inhalers were returned; most inhalers (75.5%) were pMDIs. During this time, Take AIR saved the equivalent of an estimated 305.3 tonnes of carbon dioxide emissions from entering the atmosphere.

UHL brought necessary clinical skills and experience, plus regional networks and contacts to involve the right people.

LPC provided leadership support to encourage community pharmacies to participate voluntarily.

UK-CHI-2300406 July 2023