Environmental sustainability in respiratory care: Engagement among Canadian healthcare professionals

RATIONALE Healthcare contributes substantially to global environmental harm, but targeted sustainability initiatives can mitigate this impact. In respiratory medicine, inhalers represent a key area of concern due to the high carbon footprint of metered-dose inhalers and significant material waste.OBJECTIVES We sought to identify practices for sustainable inhaler use in Canadian healthcare settings.METHODS Healthcare professionals (HCPs) were invited via professional societies and nonprofit organizations to complete an online survey (November 2024-March 2025). Descriptive statistics and logistic regression were used to summarize and compare engagement in patient education (inhaler technique training/disposal advice) across professions and to describe HCP knowledge and implementation of sustainable practices in pulmonary function testing (PFT) settings, hospitals and pharmacies.RESULTS A total of 430 HCPs responded to the survey (median age: 41 years (IQR: 34–50); 74% female; 30% physicians). Among all respondents, 83% indicated they provide inhaler technique training, 49% reported providing training to all or nearly all patients initiating inhaler therapy, and 21% reported doing so for current inhaler users. Only 28% of respondents were aware of inhaler recycling/disposal programs in their region, among whom 41% never or rarely advised patients on inhaler disposal. Among respondents performing PFT, 36% indicated inhalers were not re-used across patients. Workplace initiatives for sustainable inhaler use included initiatives aimed at HCP/patient awareness, prescribing practices, formulary changes, reducing wasteful practices and recycling/disposal.CONCLUSIONS Gaps and corresponding opportunities exist for healthcare professionals to advance sustainability in respiratory care through improved patient education, more efficient inhaler usage and better inhaler disposal.