Murphy Anna C, Carroll Will, Gotsell Marissa, Potter Charles, Quint Jennifer K, Malone Rachel
University Hospitals of Leicester NHS Trust, Leicester, UK.
School of Pharmacy, De Montfort University, Leicester, UK.
BMJ Open Respir Res. 2024 Dec 25;11(1):e002579. doi: 10.1136/bmjresp-2024-002579.
Inhalers are widely used for the management of asthma and chronic obstructive pulmonary disease. However, there is little knowledge about the extent to which an inhaler is used and when it is disposed of, despite the implications for an individual's health (when used beyond the recommended number of doses (overused)), and medicine wastage, healthcare costs and the environment (when discarded with remaining doses (underused)). To explore inhaler use, we assessed the number of doses remaining in pressurised metered-dose inhalers (pMDIs) returned via a Chiesi Inhaler Recycling scheme.
pMDIs were dismantled, and components recycled where possible. Each canister was weighed and the mass of the formulation remaining was calculated. pMDIs were categorised based on number of doses remaining (underused, used, empty (indicating correct use) and overused) and by dose counter presence/absence. A separate online survey was used to obtain patient feedback on inhaler use and disposal behaviours.
Overall, 2614 pMDIs were analysed (55.9% maintenance, 44.1% reliever inhalers); 1015 (38.8%) had an integrated dose counter. The proportion of pMDIs returned empty was greater for inhalers with dose counters than for those without (51.3% vs 25.1%; p<0.0001); the proportion of pMDIs returned underused was lower for inhalers with dose counters than for those without (5.2% vs 33.2%; p<0.0001). The proportion of pMDIs returned overused was substantial and similar for devices with and without dose counters (34.0% vs 23.2%; p>0.01). Most respondents (55.2%) using devices without a dose counter reported that they were not confident in identifying when their inhaler was empty. Furthermore, many respondents (20.6%) who used inhalers with a dose counter reported continued use beyond 'zero'.
Our study suggests that many inhalers are returned underused or overused, with inadequate knowledge among patients about the number of therapeutic doses remaining in the device and appropriate inhaler disposal. These have concerning implications for patient health and the environment and highlight a need for high-quality education for patients and healthcare professionals.
吸入器广泛用于哮喘和慢性阻塞性肺疾病的治疗。然而，尽管吸入器的使用情况及其丢弃时间对个人健康（如使用超过推荐剂量（过度使用））、药物浪费、医疗成本和环境（如剩余剂量时丢弃（未充分使用））有影响，但人们对这些情况知之甚少。为了探究吸入器的使用情况，我们评估了通过齐氏吸入器回收计划回收的压力定量吸入器（pMDIs）中剩余的剂量数。
拆解pMDIs，并尽可能回收其组件。对每个药罐进行称重，并计算剩余制剂的质量。根据剩余剂量数（未充分使用、已使用、空罐（表明使用正确）和过度使用）以及是否有剂量计数器对pMDIs进行分类。通过一项单独的在线调查获取患者关于吸入器使用和处置行为的反馈。
总体而言，共分析了2614个pMDIs（55.9%为维持用吸入器，44.1%为缓解用吸入器）；1015个（38.8%）有集成剂量计数器。有剂量计数器的吸入器空罐回收比例高于无剂量计数器的吸入器（51.3%对25.1%；p<0.0001）；有剂量计数器的吸入器未充分使用回收比例低于无剂量计数器的吸入器（5.2%对33.2%；p<0.0001）。有剂量计数器和无剂量计数器的设备过度使用回收比例都很高且相似（34.0%对23.2%；p>0.01）。大多数使用无剂量计数器设备的受访者（55.2%）表示，他们不确定何时吸入器已空。此外，许多使用有剂量计数器吸入器的受访者（20.6%）表示在剂量显示“零”后仍继续使用。
我们的研究表明，许多吸入器回收时未充分使用或过度使用，患者对设备中剩余治疗剂量数及正确的吸入器处置方法了解不足。这些情况对患者健康和环境都有令人担忧的影响，并凸显了对患者和医护人员进行高质量教育的必要性。
