Inhalers for the alleviation of respiratory diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD) are increasingly coming into the sustainability spotlight due to their total carbon footprint. This publication summarizes recent discussions at an industry forum convened to discuss the development of next generation, environmentally benign pressurized metered dose inhalers (pMDIs). The aim is to develop sustainable pMDIs using near zero Global Warming Potential propellants thereby reducing the carbon footprint associated with respiratory drug delivery. An integrated collaborative approach, involving all stakeholders, will be critical to the delivery of low carbon inhalers, a task comparable in scale to the phase out of CFCs triggered by the Montreal Protocol. Lessons learned from this earlier transition can support efforts towards more sustainable pMDIs that will maintain patient health while simultaneously reducing environmental harms.