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Background The UK has taken steps to promote sustainability in respiratory medicine, with policies focusing on reducing the environmental impact of inhalers by increasing low-carbon inhaler prescription and supporting patients on low-carbon inhalers vis-à-vis the NHS net zero plan, BTS/SIGN/NICE guidance and the UK Government’s Environment Act 2021. Pharmaceutical companies and others have also led pilot inhaler recycling schemes, and in 2023, an inhaler waste recycling company, Grundon, was launched. However, evidence of improvements remains patchy and organised approaches to bring the literature together into actionable insights have been lacking. This mixed methods study builds on our previous systematic review (n=63 included studies, PROSPERO CRD42024541927) to bring together survey and qualitative data and generate actionable insights using the people, product and process framework.Methods Two online surveys for patients and healthcare professionals (HCPs) were disseminated via social media, respiratory HCP associations, Asthma+Lung UK and other charities in respiratory health. Interviews with stakeholders along the inhaler prescription-use-disposal pathway were conducted and analysed using the Framework method. The study took place between August 2024 and January 2025, with ethical approval obtained from the University of Birmingham.Results 141 people completed the surveys, and 27 interviews were conducted. Amongst HCPs completing the survey, 86% were aware of appropriate inhaler disposal and recycling, but only 12.5% had a formal inhaler disposal or recycling program in place. Limitations identified included policies, resources and infrastructure, with primary care participants being more likely than others to identify inadequate infrastructure as a barrier (63 vs 38%, p<0.02). 54% of patients identified their inhalers by colour, while 43% supported the removal of colours from inhalers to reduce environmental impact. Qualitative insights included uncertainty over responsibility for inhaler returns collection between GPs and community pharmacies, lack of incentives to return inhalers and need for patient education on inhaler adherence and use techniques.Conclusion Actionable insights include routine patient education on sustainable inhaler use, low-carbon prescribing as defaults, and standardised inhaler disposal guidance, infrastructure and pathways as priority projects to improve sustainability in respiratory medicine.