10055368Reducing the environmental impact of Metered Dose Inhalers with aflo, the automated inhaler technique platformClosedGrant for R&DInnovate UKGlobally, more than 750M people live with asthma and chronic obstructive pulmonary disease (COPD). Uncontrolled symptoms of these conditions cost $34B in the US and £1.5B in the UK annually. Pressurised metered-dose inhalers (MDIs) were introduced in 1956 for the treatment of asthma and COPD, followed by Dry Powder Inhalers (DPIs) in the 1980's. Evidence shows that 86% of inhaler users make at least one technique error and optimising drug delivery to control symptoms remains a world-wide problem. Inexpensive, generic MDIs play a vital role but the propellants they use are a significant contributor to Green House Gases (GHG). A low carbon propellant, HFA 152a is in development, due to be introduced in 2025\. The NHS Net Zero target focused attention on the Global Warming Potential (GWP) of inhalers, identifying a reduction of MDI usage as a policy objective. Recently concerns have been raised about the wider societal and environmental impact of this policy. Emerging evidence (Jeswani et al 2019) suggests the wider environmental impact of DPIs - fossil depletion, terrestrial acidification, marine and freshwater eutrophication, marine and freshwater ecotoxicity - is greater than that of MDIs. The NHS Net Zero policy may have unintended environmental consequences. Additionally, switching MDI users to DPIs carries patient risk. Solutions are needed that address the broader environmental impact, while ensuring patients are not put at risk of losing control of symptoms if inhaler choice is not appropriate. In previous Innovate UK supported research and development, Respiratory Analytics designed and built a deep tech platform, aflo(tm). It automates correct inhaler technique via the integration of a medical grade data capture device, a user co-designed app with real-time feedback, a clinician portal and a cloud-hosted data analytics hub, to improve symptom control and patient self management and to provide quantified clinician remote monitoring. Like many pharmaceutical products there is limited data on the environmental impact of respiratory inhalers. This project seeks to provide primary evidence that automating inhaler technique for MDIs with aflo(tm) will lower the environmental impact of MDIs by optimising drug deposition of lower GWP 'preventer' (corticosteroid) inhalers, controlling symptoms, so reducing the need for high GWP 'reliever' (short acting beta agonist - SABA) inhalers. A second aspect of the research will investigate appropriate disposal/ recycling of MDIs. Our real world inhaler technique project will contribute to the very important emerging body of research into inhaler environmental impacts.