A mixed-methods assessment of inhaler sustainability across the respiratory care pathway

Abstract Inhalers are central to asthma and COPD care but contribute to the environmental impact of respiratory services. Sustainability efforts have often focused on reducing device-level carbon emissions, particularly through switching from pressurised metered-dose inhalers to lower-carbon alternatives. However, the factors shaping sustainability across the wider respiratory care pathway are poorly understood. This study used a convergent mixed-methods design, informed by socio-technical systems theory, to examine inhaler sustainability across the UK respiratory care pathway. Qualitative interviews were conducted with patients, healthcare professionals, policymakers, industry representatives, and sustainability experts (n = 29). In parallel, surveys were administered to patients to explore inhaler appearance and recognition (n = 65) and to healthcare professionals to examine disposal and recycling practices (n = 76). Findings suggest that interconnected factors, including device design, regulation, prescribing systems, patient usability, and end-of-life infrastructure, shape inhaler sustainability. Sustainability was typically secondary to clinical considerations in prescribing decisions, and recycling pathways were poorly integrated into routine care. These findings highlight the need for whole-system approaches to improving inhaler sustainability while maintaining clinical safety, usability, and equitable respiratory care.