If the healthcare system were a country, it would be the fifth most polluting in the world in terms of global warming. Moreover, between 25% and 50% of its carbon footprint is due to medications, with pressurized inhalers being among the most impactful on the environment. To raise patient awareness about the importance of correctly recycling them at the SIGRE Point in pharmacies, the Hospital de Sant Pau and the Sant Pau Research Institute (IR Sant Pau) have launched the multicenter GIMAFH project, which involves 42 other hospitals across Spain with the support of the Spanish Society of Hospital Pharmacy (SEFH). In fact, experts estimate that if inhalers were recycled properly, over 100,000 tons of CO2 emissions could be avoided annually.
Inhalers, of which 15 million units are sold annually in Spain, are among the most polluting medical devices, mainly because they contain gases called hydrofluoroalkanes that have a potency between 1,300 and 3,500 times greater than CO2 and contribute to the greenhouse effect: using each inhaler is equivalent to 300 kilometers of car CO2 emissions. Additionally, they also contain other components, such as plastic, metal, cardboard, and paper, which must also be correctly recycled at the SIGRE point, where they are sent to the treatment plant for packaging and medical waste, sorted, and given the most appropriate treatment in each case.
“Many times, mainly due to lack of knowledge, inhalers are thrown directly into the trash or the yellow container, but their components require specific treatment to prevent environmental damage,” explains Noé Garin, a researcher in the Pharmacy Research Group at IR Sant Pau and assistant at the Pharmacy Service of the Hospital de Sant Pau. Despite the significant impact inhalers have, “they are essential bronchodilator medications for treating respiratory diseases like asthma or COPD, and we cannot stop administering them to patients. Faced with this situation, we considered what we could do as healthcare professionals and as a hospital, and this has been the starting point of the GIMAFH project.”
The GIMAFH project, led by Sant Pau, is carried out with the participation of 42 hospitals across Spain and with the support of the SEFH. Its first objective is “to know the degree of awareness of the patients who come to the hospital to collect their medication about the environmental impact of pressurized inhalers and also to know what management they make of these wastes once the treatment is finished, has expired, or if their doctor has modified the prescription and they will no longer use it. We do this with a brief survey that also allows us to know if there are certain personal factors that influence this greater or lesser awareness: age, sex, health status…”.
In this phase, patients are also provided with an explanatory infographic of the different parts and components of the inhaler, with data illustrating its environmental impact, “such as that if their inhaler were a car, it would emit 30 kg of CO2, equivalent to 300 km of car emissions,” and information that they should always take them to the SIGRE point at their pharmacy to recycle them and minimize their environmental impact. “It’s about empowering patients in this regard,” says Noé Garin.
In a second phase of the GIMAFH project, which is carried out three months after the first, patients are re-contacted to see if the information initially provided has translated into better awareness of the environment and also about the handling and recycling of inhalers. This data will be available towards the end of the year.
Although the first phase of the GIMAFH project has been carried out with about 400 asthma patients, “the idea is to extend it to other respiratory diseases where pressurized inhalers are also prescribed, such as chronic obstructive pulmonary disease (COPD) and also to patients not only adults but also children…”, explains Noé Garin.
Another future goal is that the informative infographic “is available to all hospitals in Spain -both for those who have participated in the project and for the rest- for Primary Care and for various professional profiles: doctors, nurses, pharmacists… because together we can carry out proper management and recycling of these wastes.”
Another step, further ahead and related to these goals of reducing the environmental impact of inhalers, would be to work on a “green prescription project” for these devices. This means exploring whether it is possible to opt for other types of inhalers that are not pressurized, depending on the needs and characteristics of each patient,” concludes Noé Garin
