INTRODUCTIONThe 2018 Cape Town Declaration identifies the activities of the tobacco industry as incompatible with the human right to health1. The Global Burden of Disease Study estimates the annual global death toll from smoking to be 8.71 million2. Through the cultivation, production, processing and disposal of its products, the industry creates a substantial burden on the environment, which falls mainly in low and middle-income countries3. Tobacco multinationals stand condemned as a major obstacle to the achievement of the UN’s sustainable development goals4.Based on its market share of at least 12% of cigarettes sold worldwide, (https://tobaccotactics.org/wiki/philip-morris-international/), Philip Morris International (PMI) kills more than a million people per year. PMI’s bid to take over Vectura, an inhaler company whose products are used extensively by people with COPD and asthma, conditions caused and aggravated by its products, is therefore a cause for concern. A range of consequences follow from such a takeover. Vectura, its employees, and anyone continuing to work for or collaborate withVectura, become excluded from membership of respiratory professional societies as well as collaboration with academic institutions, on grants and from publication in medical journals5,6. The details of these policies vary, but as an example, the European Respiratory Society excludes anyone with tobacco industry links in the last 10 years. Many Vectura scientists will choose to leave rather than face long-term pariah status. Policies that exclude the tobacco industry from interaction with government (Article 5.3 of the WHO’s Framework Convention on Tobacco Control) would also apply to Vectura.Vectura currently receives income from the sale of a range of inhalers currently in widespread use. If a takeover by PMI goes ahead, The European Respiratory Society states that “health professionals will avoid prescribing drugs from any company that enriches the tobacco industry due to the ethical implications”.5 Patients with lung disease are also likely to be reluctant to use tobacco industry linked devices.We discuss the ethical issues raised around choice of medication in this context, and present potential alternative medications for clinicians, commissioners and patients considering switching.