To the Editor In the recent Perspective by Dr Alkhunaizi and colleagues titled “Reducing Inhaler-Related Greenhouse Gas Emissions,” the intervention recommended, switching from metered-dose inhalers to dry-powder inhalers, may not reduce the environmental impact as expected. The environmental impact of inhalers extends beyond carbon emissions alone; it also includes factors such as fossil fuel and metal depletion, ozone depletion, and ocean acidification. Considering all these factors, the overall environmental impact of metered-dose inhalers vs dry-powder inhalers remains unclear.