{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:10:13Z","timestamp":1789787413773,"version":"4.0.1"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can J Hosp Pharm"],"abstract":"<jats:p>Background: Inhalers contribute to health care\u2013related 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.\nObjectives: 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.\nMethods: 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\u2013surgery 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\u2019 medication administration records.\nResults: 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.\nConclusions: This study showed significant inhaler waste in the hospital setting, which contributes to the health care\u2013related 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.\nKeywords: drug waste, multidose medications, inhalers, greenhouse gas emissions, climate change\nR\u00c9SUM\u00c9\nContexte : Les inhalateurs contribuent aux impacts environnementaux li\u00e9s aux soins de sant\u00e9, notamment par les \u00e9missions de gaz \u00e0 effet de serre. Ils sont d\u00e9livr\u00e9s en formats multidoses, ce qui entra\u00eene du gaspillage, mais on ne conna\u00eet que peu de choses sur l\u2019impact environnemental du gaspillage d\u2019inhalateurs en milieu hospitalier.\nObjectifs : L\u2019objectif principal consistait \u00e0 quantifier le nombre de pulv\u00e9risations gaspill\u00e9es dans les services de m\u00e9decine adulte et de pneumologie d\u2019un h\u00f4pital communautaire et d\u2019un h\u00f4pital tertiaire. Les objectifs secondaires consistaient quant \u00e0 eux \u00e0 quantifier le co\u00fbt et l\u2019empreinte carbone des doses gaspill\u00e9es, \u00e0 d\u00e9terminer le taux de distribution d\u2019inhalateurs en double et \u00e0 quantifier la pr\u00e9valence des inhalateurs d\u00e9livr\u00e9s, mais non utilis\u00e9s par les patients.\nM\u00e9thodologie : Pour cette \u00e9tude r\u00e9trospective multicentrique bas\u00e9e sur l\u2019examen des dossiers, le service informatique de la pharmacie a produit un rapport sur les patients adultes hospitalis\u00e9s \u00e0 qui la pharmacie des services de pneumologie et de m\u00e9decine g\u00e9n\u00e9rale d\u2019un h\u00f4pital tertiaire de 500 lits ou du service de m\u00e9decine-chirurgie d\u2019un h\u00f4pital communautaire de 48 lits avait d\u00e9livr\u00e9 au moins un inhalateur au cours de trois mois distincts (pendant l\u2019exercice 2021\u20132022). Le nombre d\u2019inhalateurs d\u00e9livr\u00e9s a \u00e9t\u00e9 compar\u00e9 au nombre de doses document\u00e9es dans les fiches d\u2019administration des m\u00e9dicaments des patients.\nR\u00e9sultats : Dans cette \u00e9tude, 211 inhalateurs (23 031 pulv\u00e9risations) ont \u00e9t\u00e9 d\u00e9livr\u00e9s pour 132 patients. Parmi ce nombre, 81,9 % des pulv\u00e9risations ont \u00e9t\u00e9 gaspill\u00e9es, pour un co\u00fbt total de 6 172,82 $ sur les trois mois \u00e0 l\u2019\u00e9tude. Pour 22 patients (16,7 %), au moins un inhalateur a \u00e9t\u00e9 d\u00e9livr\u00e9 sans qu\u2019aucune dose n\u2019ait \u00e9t\u00e9 administr\u00e9e; pour 16 patients (12,1 %), un inhalateur a \u00e9t\u00e9 d\u00e9livr\u00e9 deux fois. L\u2019empreinte carbone des doses gaspill\u00e9es s\u2019\u00e9levait \u00e0 1 226 342 grammes d\u2019\u00e9quivalent dioxyde de carbone, soit l\u2019\u00e9quivalent de 5951 km parcourus en voiture.\nConclusions : Cette \u00e9tude a mis en \u00e9vidence un gaspillage important d\u2019inhalateurs en milieu hospitalier, qui contribue \u00e0 l\u2019empreinte carbone des soins de sant\u00e9, sans contribuer aux soins pour les patients. Ces r\u00e9sultats soul\u00e8vent des questions importantes sur la mani\u00e8re de continuer \u00e0 offrir des soins de haute qualit\u00e9, tout en r\u00e9duisant l\u2019empreinte carbone et les co\u00fbts pour les soins de sant\u00e9.\nMots-cl\u00e9s: gaspillage de m\u00e9dicaments, m\u00e9dicaments multidoses, inhalateurs, \u00e9missions de gaz \u00e0 effet de serre, changement climatique<\/jats:p>","DOI":"10.4212\/cjhp.3606","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T20:20:04Z","timestamp":1744834804000},"source":"Crossref","is-referenced-by-count":1,"title":["Counting the Carbon: Quantifying Financial and Environmental Implications of Wasted Inhaler Doses in the Hospital Setting"],"prefix":"10.4212","volume":"78","author":[{"given":"Alison","family":"Bentley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Culley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stoynova","family":"Valeria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2732","published-online":{"date-parts":[[2025,4,9]]},"container-title":["Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3606\/5586","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3606\/5587","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3606\/5586","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T14:41:01Z","timestamp":1751985661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/3606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,9]]},"references-count":0,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,4,9]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.3606","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"value":"1920-2903","type":"electronic"},{"value":"0008-4123","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4,9]]},"article-number":"e3606"}}