Behaviour change intervention for inhaler disposal, Spain.

Objective: To analyse metered-dose inhaler disposal behaviour in asthma patients, determine the patient characteristics that contribute to appropriate disposal and quantify the effect of a pharmacy-led educational intervention. Methods: We conducted a multicentre cross-sectional study in 40 Spanish hospitals followed by a pre-post quasi-experimental evaluation. We surveyed adults with uncontrolled severe asthma receiving biological therapy to determine sociodemographic, health, environmental attitude and disposal behaviour characteristics. At the time of biological therapy dispensation, we provided patients with an infographic on inhaler environmental impact and appropriate disposal. We resurveyed participants 3 months later to assess changes in knowledge, attitude and disposal behaviour. We identified factors associated with correct inhaler disposal and quantified the impact of the intervention using a multivariate logistic regression and McNemar test, respectively. Findings: Despite 86.7% (435/502) of our study participants valuing environmental conservation and 91.6% (460/502) being aware of medication disposal programmes, only 46.6% (234/502) correctly disposed of inhalers. Factors associated with appropriate disposal included practising household recycling, high perception of inhaler environmental impact, awareness of medication disposal programme, low income and self-reported limitations to daily activities. On resurveying patients 3 months after our pharmacy-led intervention, we observed an increase in correct inhaler disposal to 84.1% (418/497) with parallel gains in awareness and recycling behaviours. Conclusion: We revealed a discrepancy between the environmental concerns of asthma patients and inhaler disposal behaviour, due to limited knowledge of inhaler environmental impact. We demonstrated that this knowledge gap can be reduced, doubling the correct disposal of inhalers, through a targeted pharmacy-led intervention.