Are we handling used metered dose inhaler canisters safely? – A call for action to address an environmental hazard

Background: Metered dose inhalers (MDI) are preferred treatment for asthma and chronic obstructive pulmonary disease. The used MDI canisters are to be disposed off in appropriate manner to prevent environmental pollution. In this study, the disposal methods followed by the patients were investigated. Methodology: This study was conducted in out-patient setting in departments of pulmonary medicine of a tertiary care teaching hospital in south Kerala. The Any patient who was using MDI for at least past one year was enrolled into the study. Exhaustive sampling was done over a period of six months to obtain interviews of 883 patients. Age, gender and educational status of participants, disposal methods they followed for MDI canisters and the source of information for the disposal methods were enquired. Results: Among the 883 patients who were interviewed, 46% were females and 54% were males and 57% were older persons (age above 60 years). All of them were using MDI for at least past one year. None of them were informed about the correct methods of disposal of used MDI canisters (recycle or incineration or plasma pyrolysis). Majority (79%) of the participants disposed them in the waste bins or into the general waste heaps, 13.7% of the participants burned them in their courtyard and 7 (0.8%) participants stored them and 3 (0.4%) used to flush down them in the toilet. Conclusions: MDI canister disposal is an unaddressed environmental hazard. Take back programs need to be initiated to recycle them or at least to incinerate them safely according to Biomedical Waste Management and Handling Rules. ‘Complete the Cycle’ scheme in United Kingdom can be a model for a recycling project venture. Incineration is currently possible through IMAGE project (IMA Goes Eco-friendly) which is currently run in Kerala. Keywords: Biomedical waste management; Metered dose inhaler; Inhalational therapy; Recycle, Take back program.