Launching and spreading an organization-wide inhaler recycling project at an academic, tertiary care hospital: insights from a quality improvement project

Background Inhalers and respiratory devices are essential for treatment of respiratory diseases yet have significant environmental impacts due to the plastic devices, packaging materials, and hydrofluorocarbons in propellants found in many inhaler devices. 1–6 These products are often disposed in landfill, contributing to climate change, which poses a significant threat to population health.1 2 Recycling opportunities for inhalers and respiratory devices are under-utilized, while patients and providers remain underinformed regarding recycling options and impacts.7 8Kingston Health Sciences Centre (KHSC) is an academic, tertiary care hospital in Southeastern Ontario, Canada, located across 2 hospital sites with both in-patient and ambulatory units. KHSC historically did not have a recycling program for inhalers and respiratory devices such that most of these materials were discarded in the garbage.Methods We identified the need to introduce a formal, organized inhaler recycling program at KHSC that would unify inpatient and outpatient clinical units towards a common goal of improving the organization’s climate footprint. Inhaler recycling started with a cardboard box and signage in the ambulatory Respirology Clinic (January 2024), serving as an initial catalyst for healthcare professional education, buy-in, and interest. Collected inhalers were returned to the pharmacy for recycling. However, we could not confirm the process for recycling materials or obtain data regarding amounts recycled. We thus procured inhaler recycling boxes from Go Zero, a company that offers an inhaler recycling program that manages the recycling of all inhaler components, including handling of respiratory devices, packaging, and aerosolized propellants. We initially procured Go Zero boxes by donation from AstraZeneca and additional boxes were purchased through University Hospital Kingston Foundation. We placed these boxes in high-use areas such as inpatient wards and ambulatory clinics (May 2025). For respirology clinics, we developed patient appointment reminders that include messaging to bring used or expired inhalers. We leveraged an educational and awareness campaign, consisting of posters, internal media communications, and external social media messaging. We engaged in academic activities regarding program impact, including the number, type, and weight of inhalers recycled. We shared and celebrated early successes by informing units of their progress in inhaler recycling. Lastly, we leveraged this project for inclusion in KHSC’s submission to Choosing Wisely Canada Hospital Designation for formal recognition.Results In terms of process measures, we collected data regarding the number of individual hospital units (wards/clinics) participating in the inhaler recycling project and the number of boxes available for recycling. The number of individual hospital units participating in inhaler recycling increased from 1 in January 2024, to 10 units in May 2025, and to 15 units as of October 2025 ( figure 1), with 19 boxes located across these units.Regarding the outcome measure, we weighed and counted the number and type of recycled inhalers and associated materials. In the 10 weeks post-Go Zero launch, 15.41 kg of recyclable materials were collected (average 6.16 kg/month). In the subsequent 12 weeks, 27.72 kg more was collected (9.24 kg/month), totalling 46.58 kg, including baseline materials (figure 2). Non-recyclable waste made up 3.6% of total weight (balancing measure). The Asthma Injection Clinic collected the most inhalers overall (9.37 kg), while the Internal Medicine wards led amongst the inpatient units (19.23 kg across 3 wards).Conclusions We successfully launched and spread an organization-wide inhaler recycling program at an academic tertiary-care centre across two hospital sites to reduce the environmental footprint of the organization. Project success was attributed to having designated QI champions, commitment to an academic evaluation, frequent and widely circulated internal and external media communications, and a growing organizational culture of environmental sustainability. By engaging patients and providers in this recycling initiative, we are reducing the environmental impact of healthcare with positive impacts on patient and population health.References UN Environmental Programme. Plastic planet: How tiny plastic particles are polluting our soil, https://www.unep.org/news-and-stories/story/plastic-planet-how-tiny-plastic-particles-are-polluting-our-soil (2021, accessed 12 March 2025).Wojnowska-Baryła I, Bernat K, Zaborowska M. Plastic waste degradation in landfill conditions: the problem with microplastics, and their direct and indirect environmental effects. IJERPH 2022;19:13223.Mikolasch TA, Stadler CI. Our prescription for climate change: reduce and recycle inhalers! Br J Gen Pract. 2020;70:30–30.Janson C, Maslova E, Wilkinson A, et al. The carbon footprint of respiratory treatments in Europe and Canada: an observational study from the CARBON programme. Eur Respir J. 2022;60:2102760.Gupta S, Couillard S, Digby GC, et al. Canadian thoracic society position statement on climate change and choice of inhalers for patients with respiratory disease. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine 2023;7:232–239.Gupta S, Couillard S, Digby G, et al. Climate change and inhaler selection in patients with respiratory disease. CHEST 2024;165:503–506.Quantz D, Wong GYC, Liang K. Patient perspectives on the environmental impact of inhalers: a survey in British Columbia. Can Pharm J. 2023;156:298–302.Murphy AC, Carroll W, Gotsell M, et al. How do patients determine when their inhaler is empty? Insights from an analysis of returned inhalers and a patient survey. BMJ Open Resp Res. 2024;11:e002579.Abstract 07 Figure 1Number of KHSC units participating in inhaler recycling, c-chart (process measure)Legend: Blue circles and lines represent special-cause variation, i.e., indicate instability in data and represent statistically significant differences; red diamonds and lines represent in-control points and trends (common-cause variation). The baseline mean is represented by a dashed light blue line, which was fixed and used to identify special-cause variation in the process moving forward. Means and control limits were recalculated when special-cause variation was demonstrated, depicted by a solid light blue line. CL, control limit; UCL, upper control limitsAbstract 07 Figure 2Weight of recycled materials (outcome measure)