An awareness of the impact of climate change has led to policies to reduce greenhouse gas emissions (GHGEs). The National Health Service (NHS) is the UK public sector’s largest emitter of greenhouse gases, with a target to deliver a net zero NHS by 2050 (NHS, 2020). Pressurised metered dose inhalers (pMDIs), which use hydrofluoroalkanes (HFA) as the propellant, have been targeted as a perceived easy option to reduce the NHS carbon footprint of HFA, as alternative inhaler devices in the form of dry powder inhalers (DPIs) and soft mist inhalers (SMIs) which contain no propellant are readily available. Balancing the environmental impact while ensuring that the best option of inhaler device is provided for individual patients can lead to conflict and confusion for healthcare professionals while waiting for manufacturers to provide pMDI with propellants that are more environmentally friendly. This article discusses sustainability, from manufacture to disposal.