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. 2025 Apr 9;78(2):e3606.
doi: 10.4212/cjhp.3606. eCollection 2025.

Counting the Carbon: Quantifying Financial and Environmental Implications of Wasted Inhaler Doses in the Hospital Setting

Alison Bentley  1 , Celia L Culley  2 , Valeria Stoynova  3
Affiliations

Counting the Carbon: Quantifying Financial and Environmental Implications of Wasted Inhaler Doses in the Hospital Setting

Alison Bentley et al. Can J Hosp Pharm. .

Abstract
in English, French

Background: Inhalers contribute to health care-related environmental impacts, particularly through greenhouse gas emissions. They are dispensed in multidose formats, which leads to waste, yet little is known about the environmental impact of inhaler waste in the hospital setting.

Objectives: The primary objective was to quantify wasted inhaler actuations on adult medicine and respiratory wards at a community and a tertiary hospital. Secondary objectives were to quantify the cost and carbon footprint of wasted doses, to determine the rate of duplicate inhaler dispensing, and to quantify the prevalence of dispensed inhalers remaining unused.

Methods: For this multicentre, retrospective chart review, the pharmacy informatics team generated a report of adult inpatients for whom one or more inhalers were dispensed from the pharmacy to the respiratory and general medicine wards at a 500-bed tertiary hospital or to the medicine-surgery ward at a 48-bed community hospital over 3 nonconsecutive months (during fiscal year 2021/22). The number of inhalers dispensed was compared with the number of doses documented on patients' medication administration records.

Results: In this study, 23 031 actuations (211 inhalers) were dispensed for 132 patients. Of these, 81.9% were wasted, at a total cost of $6172.82 over the 3 months of the study. For 22 patients (16.7%), at least one inhaler was dispensed, yet no doses were administered; for 16 (12.1%), a duplicate inhaler was dispensed. The carbon footprint of the wasted doses was 1 226 342 g carbon dioxide equivalent, equivalent to driving 5951 km by car.

Conclusions: This study showed significant inhaler waste in the hospital setting, which contributes to the health care-related carbon footprint without contributing to patient care. These results raise important questions about how to continue providing high-quality patient care while minimizing carbon footprint and health care costs.

Contexte: Les inhalateurs contribuent aux impacts environnementaux liés aux soins de santé, notamment par les émissions de gaz à effet de serre. Ils sont délivrés en formats multidoses, ce qui entraîne du gaspillage, mais on ne connaît que peu de choses sur l’impact environnemental du gaspillage d’inhalateurs en milieu hospitalier.

Objectifs: L’objectif principal consistait à quantifier le nombre de pulvérisations gaspillées dans les services de médecine adulte et de pneumologie d’un hôpital communautaire et d’un hôpital tertiaire. Les objectifs secondaires consistaient quant à eux à quantifier le coût et l’empreinte carbone des doses gaspillées, à déterminer le taux de distribution d’inhalateurs en double et à quantifier la prévalence des inhalateurs délivrés, mais non utilisés par les patients.

Méthodologie: Pour cette étude rétrospective multicentrique basée sur l’examen des dossiers, le service informatique de la pharmacie a produit un rapport sur les patients adultes hospitalisés à qui la pharmacie des services de pneumologie et de médecine générale d’un hôpital tertiaire de 500 lits ou du service de médecine-chirurgie d’un hôpital communautaire de 48 lits avait délivré au moins un inhalateur au cours de trois mois distincts (pendant l’exercice 2021–2022). Le nombre d’inhalateurs délivrés a été comparé au nombre de doses documentées dans les fiches d’administration des médicaments des patients.

Résultats: Dans cette étude, 211 inhalateurs (23 031 pulvérisations) ont été délivrés pour 132 patients. Parmi ce nombre, 81,9 % des pulvérisations ont été gaspillées, pour un coût total de 6 172,82 $ sur les trois mois à l’étude. Pour 22 patients (16,7 %), au moins un inhalateur a été délivré sans qu’aucune dose n’ait été administrée; pour 16 patients (12,1 %), un inhalateur a été délivré deux fois. L’empreinte carbone des doses gaspillées s’élevait à 1 226 342 grammes d’équivalent dioxyde de carbone, soit l’équivalent de 5951 km parcourus en voiture.

Conclusions: Cette étude a mis en évidence un gaspillage important d’inhalateurs en milieu hospitalier, qui contribue à l’empreinte carbone des soins de santé, sans contribuer aux soins pour les patients. Ces résultats soulèvent des questions importantes sur la manière de continuer à offrir des soins de haute qualité, tout en réduisant l’empreinte carbone et les coûts pour les soins de santé.

Keywords: climate change; drug waste; greenhouse gas emissions; inhalers; multidose medications.

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Conflict of interest statement

Competing interests: For activities not directly related to the study reported here, Celia Culley has received grants from the South Island Facilities Engagement Initiative and CASCADES Canada; honoraria from the BC Branch of the Canadian Society of Hospital Pharmacists (now the Canadian Society of Healthcare-Systems Pharmacy [CSHP]) and the Therapeutics Initiative; and travel funding from CSHP, the BC Branch of CSHP, and Island Health; and has served in a leadership role with the Canadian Association of Pharmacy for the Environment and the CSHP. For activities not directly related to the study reported here, Valeria Stoynova has received grants from CASCADES Canada, the South Island Facilities Engagement Initiative, and The Ottawa Hospital Academic Medical Organization; speaking honoraria from Health Quality BC, the CSHP, the Canadian Society of Internal Medicine (CSIM), the Vancouver Physicians Society, and the Victoria Division of Cardiology; and travel funding from CSHP and CSIM; and has been a member of advisory boards for the BC Guidelines and Protocols Advisory Committee and CASCADES Canada. No other competing interests were declared.

Figures

FIGURE 1
FIGURE 1
Visual representation of 5951 km. Map data © 2025 Google, INEGI.
See this image and copyright information in PMC

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