Strategy & Design:
Most of the influence regarding lowering the impact of a device is done via design strategy. Eliminating the root cause of pollution by design is the ‘easiest’ sustainable strategy of all. In engineering, there is a common phrase “Design casts the longest shadow”. Typically, design influences ~70% of the cost while materials influence 20% and labor 5%. Strategizing early on to design an inhaler with the lowest possible CO2 per dose from a cradle-to-cradle perspective would be a great initiative to strive for. If considering the development of a connected device, it is strongly recommended to modularize the function of the device and to purposefully separate the electronics from the disposable elements of the device.
Materials:
Utilising modern ‘ultra-sustainable’ materials in the design is a strategy well worth considering. Ideally, no new materials and plastics should be used to truly have the lowest possible environmental impact however, this is not always practical. Therefore, strategies such as using mass balance polymers, easily recyclable polymers, mono-material assemblies and reduction in material use (to name a few), are all useful strategies to employ.
Manufacture:
The manufacture of a device is where 100% of the actual environmental impact is typically observed even though, as previously discussed, it is not necessarily the fault of the factory nor machine operator. But still, there are ways to reduce the environmental impact of inhalation devices throughout the manufacturing stage. One potential radical strategy is distributed manufacturing and, making the devices on the same continent as where the devices are being used. Another may be to switch to hydraulic injection moulding machines, vs electric. And another may be to ensure that the energy used for the manufacturing process is generated from renewable sources such as solar or wind.
Transport & Packaging:
As with manufacturing, transportation can have notable impact on the sustainability of devices. Reducing the journey time between delivery points A & B is one potential strategy. Another strategy is using sustainable modes of transportation, such as last-mile electric trucks and lorries. Packaging the devices in environmentally friendly cartons, bags or boxes can also have a big impact. Minimising the number of materials required for packaging and increasing the ratio between the Volume of Goods: Volume of Packaging can also be beneficial in addition to understanding the supply chain constraints, end-of-chain manual handling and storage is incredibly useful.
Use:
Ensuring that the inhaler is actually used significantly affects its environmental impact. Otherwise, it’s a waste of energy and resource. Increasing the adherence and persistence of inhaler use is incredibly important for several reasons. This can be achieved early in the strategy and design stage, ensuring that the device is as easy to use through utilising user insights and effective Human Factors Engineering (HFE) strategies such as Formative Human Factors Studies. Providing Health Care Professionals (HCPs) with easy training materials such as clear instructions for use and potentially trainer devices could contribute to a greater adherence and persistence. Being able to track inhaler usage can greatly inform HPCs and even CMO’s and/or Pharmaceutical companies regarding the efficacy of their devices and inform decisions for next-generation solutions.
End of Life Management:
Knowing what to do with your old inhaler can be quite confusing and sometimes misleading. Some people say that they’re recyclable, some say they’re not, some people say that if you remove the plastic parts you can put them into household recycling bins, some say that they should be taken back to the pharmacy to be disposed of safely.
Informing the user in a clear manner regarding the disposal of their devices is incredibly useful to reduce the overall environmental impact of inhalation devices. There are lots of consumer products, especially in the food packaging industry that instruct the user to remove plastic film from the cardboard packaging prior to recycling.
NHS England encourages the use of local and manufacturer-led inhaler disposal schemes; however, they have no plans for a national inhaler recycling scheme. There have been and are several recycling programs to deal with the magnitude of inhaler device wastage. Approximately 73 million respiratory inhalers are prescribed every year in the UK.
Chiesi Leicestershire Take Air Recycling Program is a scheme launched in 2021 whereby any inhaler brand and type is accepted. Users send their old devices via prepaid postage to a waste disposal company for responsible recycling of components.
In 2012, GSK launched the Complete the Cycle program, a scheme (which has now closed down) that resulted in the recovery and recycling of 2 million inhalers, saving an estimated equivalent worth of 8,665 cars emissions in one year. The closing of the program is disappointing however, shows that it is possible and there are a lot of small local programs popping up to help reduce the end-of-life management of these devices.