Concerns about the environmental impact of the propellant gases used in pressurised metered dose inhalers (pMDIs) and the plastics used in all single-use inhaler devices have made them an important focus for efforts to reduce the environmental impact of the NHS. Patients themselves may also be concerned about the environmental impact of their inhalers and express a preference for alternatives. PCRS do not support ‘blanket switching’ of patients from one inhaler type to another. Decisions about changing a patient from one inhaler device to another type of inhaler device should be made with the patient after careful review of the patient’s current condition and within the context of delivering optimal care for the individual patient.   PCRS continues to encourage manufacturers of inhaler devices to seek materials and manufacturing processes that minimise the environmental impact, and to enable appropriate recycling of the devices they produce. PCRS encourages the development of reusable devices and low global warming potential (GWP) propellants for pMDIs. Of particular benefit is the inclusion of dose counters to ensure all available doses are used prior to disposal. In the absence of access to recycling schemes safe disposal via pharmacy return is much better than inhalers entering landfill.   Optimising treatment, adherence and inhaler technique to gain the best possible symptom control is key to reducing the environmental impact of treatment and the waste of inhalers. Every review appointment for change in treatment should be used as an opportunity to improve outcomes, including regular observed review of inhaler technique.