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NHS England has updated its 'Green plan guidance', outlining key actions for Integrated Care Boards (ICBs) and trusts to help achieve net zero carbon emissions. Among the recommended measures to reduce emissions from the medicines supply chain, organisations are asked to encourage patients to return used or expired inhalers to community pharmacies for appropriate disposal. Medicines account for approximately 25 per cent of NHS emissions, with a small number of medications contributing a large portion of this. For example, anaesthetic gases account for 2 per cent of NHS emissions, while inhalers contribute 3 per cent. The updated guidance says that organisations should build on ongoing progress in reducing these "point of use" emissions, while improving patient care and reducing waste. To address emissions from the medicines supply chain, the guidance recommends: Supporting high-quality, lower-carbon respiratory care Optimising inhaler choice by considering clinical appropriateness, the environmental impact of inhalers and patient preference Improving inhaler use and adherence Promoting the appropriate disposal of inhalers Addressing overprescribing and oversupply while ensuring support for patients in greatest need

To combat the effects of climate change, the Integrated Care System (ICS) in South East London (SEL) has initiated a pioneering inhaler recycling project. Supported by NHS England and spanning 20 community pharmacies across the region, the project marks the first nationally-funded pilot of its kind in England, targeting the reduction of greenhouse gas emissions from improperly disposed inhalers. The project, which commenced at King's College Hospital in February 2024, focuses on the recycling of pressurised metered-dose inhalers. These inhalers, due to their propellant content, contribute significantly to environmental harm, emitting gases equivalent to driving 71.8 miles in a standard petrol car.