Pressurized metered-dose inhalers contribute substantially to the health care sector's carbon footprint due to hydrofluorocarbon propellants, whereas dry powder inhalers (DPI) have a lower environmental impact. This study compares asthma treatment strategies by assessing both clinical effectiveness and carbon emissions, demonstrating that as-needed budesonide/formoterol DPI is more environmentally sustainable and clinically comparable with other treatments.