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VA Ann Arbor Healthcare System Cuts Inhaler Waste by 91%, Saving Costs and Reducing Environmental Impact

An inhaler attached to a spacer device
A metered-dose inhaler attached to a spacer device (Adobe Stock)
By Chris Arbino, Deputy Director of Communications

An initiative at VA Ann Arbor Healthcare System has significantly cut down on waste and environmental impact while saving costs associated with pulmonary function testing (PFT).

The facility implemented a new standard operating procedure (SOP) for albuterol inhaler reuse, leading to a 91.1% reduction in inhaler usage and a projected cost savings of over $46,000 within six months.

Inhalers containing hydrofluorocarbon propellants contribute significantly to greenhouse gas emissions, with metered-dose inhalers (MDIs) used by Medicare and Medicaid patients generating over 1.1 million metric tons of CO₂ equivalent annually—more than the annual electricity use of 220,000 homes. Albuterol inhalers alone account for 60% of these prescriptions.

In November 2023, the VA Ann Arbor Healthcare System assembled a multidisciplinary task force, including respiratory care, pharmacy, infection control, and patient safety representatives, to assess albuterol usage and explore ways to cut down emissions and costs. The hospital implemented a new protocol in December 2023 requiring each PFT room to use a single shared albuterol inhaler, stored in a drawer and sanitized between uses. A new spacer device with a one-way valve was provided for each patient to ensure safety.

The changes made by the task force showed immediate results:

  • Before the new SOP (January–December 2023), the PFT lab used 117.7 inhalers per month, resulting in an estimated 1,494.4 kg of CO₂ emissions and costs of $8,709.70 per month.
  • After the SOP implementation (January–June 2024), inhaler usage dropped to 10.2 per month, cutting emissions to 129.1 kg of CO₂ and costs to $752.53 per month.
  • Despite a 20.7% increase in bronchodilator testing, the initiative resulted in 624 fewer inhalers used, avoiding 7,924.8 kg of CO₂ emissions—equivalent to driving a gasoline-powered car from New York City to San Francisco seven times.

“This initiative demonstrates that small, practical changes can have a significant impact,” said Dr. Alexander Rabin, pulmonologist at VA Ann Arbor Healthcare System and lead author of the study. “By dramatically reducing unnecessary inhaler waste, we not only lessen our environmental footprint but also free up resources that can be redirected toward essential services for Veterans.”

Patient safety was not affected by the new changes. Each patient receives a new spacer device, eliminating the risk for cross-contamination. Between January to June 2024, no reported cases of device-related infections were reported. 

This initiative aligns with global efforts to reduce healthcare-related emissions and provides a model for other VA and non-VA hospitals to adopt similar cost-saving and environmentally friendly strategies. Further research is recommended on expanding metered-dose inhaler recycling programs and transitioning to propellant-free inhalers.

The success of this project highlights the potential for policy changes in healthcare facilities nationwide, reducing both financial and environmental burdens while maintaining high patient care standards.